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20. An important independent nursing action to promote normal progress in labor is a. assessing the fetus. b. encouraging urination about every 1 to 2 hours. c. allowing the woman to stay in her preferred position. d. regulating intravenous fluids.

ANS: B The bladder can reduce room in the woman's pelvis that is needed for fetal descent and can increase her discomfort. Assessment of the fetus is an important task, but will not promote normal progression of labor. Position changes help labor progress and should be encouraged. Maintaining hydration is an important task, but it will not promote normal progression of labor.

8. The role of the nurse in family planning is to a. advise couples on which contraceptive to use. b. educate couples on the various methods of contraception. c. decide on the best method of contraception for the couple. d. refer the couple to a reliable physician.

ANS: B The nurse's role is to provide information to the couple so that they can make an informed decision about family planning. The nurse should not advise the couple or pick the best method for them, nor does he or she need to refer couples for information about contraceptives.

16. With regard to the use of intrauterine devices (IUDs), nurses should be aware that a. return to fertility can take several weeks after the device is removed. b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c. IUDs offer the same protection against sexually transmitted diseases as the diaphragm. d. consent forms are not needed for IUD insertion.

ANS: B The woman has up to 5 days to insert the IUD after unprotected sex. Return to fertility is immediate after removal of the IUD. IUDs offer no protection for sexually transmitted diseases. A consent form and a negative pregnancy test are required for insertion.

2. A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will probably be prescribed for continuation of the tocolytic effect? a. Ritodrine b. Terbutaline c. Calcium gluconate d. Pitocin

ANS: B The woman receiving decreasing doses of magnesium sulfate is often switched to oral terbutaline to maintain tocolysis for 48 hours. The terbutaline will probably be discontinued prior to discharge. Ritodrine is the only drug approved by the FDA for tocolysis; however, it is rarely used because of significant side effects. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Pitocin is used to augment labor, not stop it.

5. Which statement by the patient indicates that she understands breast self-examination? a. "I will examine both breasts in two different positions." b. "I will perform breast self-examination 1 week after my menstrual period starts." c. "I will examine the outer upper area of the breast only." d. "I will use the palm of the hand to perform the examination."

ANS: B The woman should examine her breasts when hormonal influences are at a low level, typically the week after her menses. Women who don't menstruate should pick a date and perform SBE on that date every month. She should use four positions: standing with arms at her sides, standing with arms raised above her head, standing with hands pressed against hips, and lying down. The entire breast needs to be examined, including the outer upper area. She should use the sensitive pads of the middle three fingers.

25. The nursing student observes a laboring woman doing lunges to the left side and asks for an explanation of this activity. What response by the nurse is best? a. It decreases the pain associated with back labor. b. It promotes rotation of the fetal occiput to an anterior position. c. It relieves the cramping associated with a prolonged labor. d. It causes the pelvic inlet to open wider in preparation for birth.

ANS: B This action encourages rotation of the fetal head to the anterior position. It does relieve back labor, but this response does not explain why. It does not relieve cramping or open the pelvic inlet.

4. In terms of the incidence and classification of diabetes, maternity nurses should know that a. type 1 diabetes is most common. b. type 2 diabetes often goes undiagnosed. c. there is only one type of gestational diabetes. d. type 1 diabetes may become type 2 during pregnancy.

ANS: B Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe. Type 2, previously called adult onset diabetes, is the most common. There are 2 subgroups of gestational diabetes. Type GDM A1 is diet-controlled whereas type GDM A2 is controlled by insulin and diet. People do not go back and forth between type 1 and type 2 diabetes.

7. A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests a. uterine atony. b. lacerations of the genital tract. c. perineal hematoma. d. infection of the uterus.

ANS: B Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction. The fundus is not firm with uterine atony. A hematoma would be internal. Swelling and discoloration would be noticed, but bright bleeding would not be. With an infection of the uterus there would be an odor to the lochia and systemic symptoms such as fever and malaise.

25. When assessing a woman for menopausal discomforts, the nurse expects the woman to describe the most frequently reported discomfort, which is a. headaches. b. hot flashes. c. mood swings. d. vaginal dryness with dyspareunia.

ANS: B Vasomotor instability, in the form of hat flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman. Headaches are not a commonly reported symptom. Mood swings and vaginal dryness with dyspareunia do occur but are not the most commonly reported symptom.

A woman has several relatives who had gestational hypertension and wants to decrease her risk for it. What information does the nurse provide this woman? (Select all that apply.) a. There is no way to reduce risk factors for gestational hypertension. b. Losing weight before you get pregnant will help prevent it. c. Eating a diet high in protein and iron may help prevent it. d. The father contributes no risk factors for hypertension in pregnancy e. Waiting until you are 35 to get pregnant cuts the risk in half.

ANS: B, C There are many risk factors for gestational hypertension, including obesity and anemia. The woman can take action to address these factors prior to becoming pregnant. The father's risks include the first baby and having fathered other preeclamptic pregnancies. Maternal age >35 increases the risk.

1. What are modes of heat loss in the newborn? (Choose all that apply.) a. Perspiration b. Convection c. Radiation d. Conduction e. Urination

ANS: B, C, D Feedback Correct Convection, radiation, evaporation, and conduction are the four modes of heat loss in the newborn. Incorrect Perspiration and urination are not modes of heat loss in newborns.

1. Late in pregnancy, the woman's breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Some nipple conditions make it necessary to provide intervention before birth. These include (select all that apply) a. Everted nipples b. Flat nipples c. Inverted nipples d. Nipples that contract when compressed e. Cracked nipples

ANS: B, C, D Feedback Correct Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling them between the fingers. Inverted nipples are retracted into the breast tissue. These nipples appear normal; however, they will draw inward when the areola is compressed by the infant's mouth. Dome-shaped devices known as breast shells can be worn during the last weeks of pregnancy and between feedings after birth. The shells are placed inside the bra with the opening over the nipple. The shells exert slight pressure against the areola to help the nipples protrude. The helpfulness of breast shells is debated. A breast pump can be used to draw the nipples out before feedings after delivery. Incorrect Everted nipples protrude and are normal. No intervention will be required. Cracked, blistered, and bleeding nipples occur after breastfeeding has been initiated and are the result of improper latch. The infant should be repositioned during feeding. Application of colostrum and breast milk after feedings will aid in healing.

1. The causes of preterm labor are not fully understood although many factors have been associated with early labor. These include (Select all that apply.) a. Singleton pregnancy b. History of cone biopsy c. Smoking d. Short cervical length e. Higher level of education

ANS: B, C, D A history of cone biopsies, smoking, and a short cervical length are all associated with early labor. Singleton pregnancy and higher level of education are not.

What assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? (Select all that apply.) a. Urine output 40 mL/hour for the past 2 hours b. Serum creatinine 3.1 mg/dL c. Seeing "sparkly" things in the visual field d. Crackles in both lungs e. Soft, non-tender abdomen

ANS: B, C, D Signs of severe preeclampsia include elevated creatinine, seeing sparkles, and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign.

1. Nurses must be aware of the conditions that increase the risk of hemorrhage, one of the most common complications of the puerperium. What are the conditions? Select all that apply. a. Primipara b. Rapid or prolonged labor c. Overdistention of the uterus d. Uterine fibroids e. Preeclampsia

ANS: B, C, D, E Feedback Correct Rapid or prolonged labor, overdistention of the uterus, uterine fibroids, and preeclampsia are all risk factors for postpartum hemorrhage. Incorrect Grand multiparity (5 or more pregnancies) is a risk factor for postpartum hemorrhage. Other risk factors include retained placenta, placenta previa, previous postpartum hemorrhage or placenta accreta, drugs (magnesium sulfate, tocolytics, oxytocin), and operative procedures.

2. The nurse teaches women to recognize signs of complications when using oral contraceptives using the acronym ACHES. What does this acronym stand for? (Select all that apply.) a. Aching all over b. Chest pain, dyspnea, hemoptysis, cough c. Severe headache, weakness or numbness of extremities, and hypertension d. Eye problems e. Several swollen areas all over the body

ANS: B, C, D, E ACHES stands for Abdominal pain (severe,) Chest pain, dyspnea, hemoptysis, cough, severe Headache, severe weakness or numbness of extremities, hypertension, Eye problems, and severe pain or Swelling, heat, or redness of calf or thigh. It does not include aching all over.

4. A woman just received an injection of carboprost, 2500 mcg IM. What actions by the nurse take priority? (Select all that apply.) a. Assess for nausea and vomiting b. Assess fetal well-being. c. Administer acetaminophen for headache. d. Monitor urine output. e. Notify the provider immediately.

ANS: B, E The usual dose of carboprost is 250 mcg, so this excessive dose could lead to uterine rupture. The nurse monitors the woman for signs of this and continually monitors the fetus for well-being. The provider would be notified and agency policy followed for variance reporting. Nausea, vomiting, and headache are side effects of the usual dose of the drug. This drug is excreted through urine, so monitoring urine output is important but not as critical as checking fetal well-being and notifying the provider.

22. The best way for the nurse to promote and support the maternal-infant bonding process is to a. Help the mother identify her positive feelings toward the newborn. b. Encourage the mother to provide all newborn care. c. Assist the family with rooming-in. d. Return the newborn to the nursery during sleep periods.

ANS: C A Having the mother express her feelings is important, but it is not the best way to promote bonding. B The mother needs time to rest and recuperate; she should not be expected to do all of the care. C Close and frequent interaction between mother and infant, which is facilitated by rooming-in, is important in the bonding process. This is often referred to as the mother-baby care or couplet care. D The mother needs to observe the infant during all stages so she will be aware of what to expect when they go home.

20. On observing a woman on her first postpartum day sitting in bed while her newborn lies awake in the bassinet, the nurse should a. Realize that this situation is perfectly acceptable. b. Offer to hand the baby to the woman. c. Hand the baby to the woman. d. Explain "taking in" to the woman.

ANS: C A This is expected behavior during the taking-in phase. However, interventions can facilitate infant bonding. B The woman is dependent and passive at this stage and may have difficulty making a decision. C During the "taking-in" phase of maternal adaptation, in which the mother may be passive and dependent, the nurse should encourage bonding when the infant is in the quiet alert stage. This is done best by simply giving the baby to the mother. D She learns best during the taking-hold phase.

A pregnant woman has been diagnosed with gestational hypertension and is crying. She asks the nurse if this means she has to take blood pressure medicine for the rest of her life. What answer by the nurse is best? a. "Yes, you will have hypertension for the rest of your life." b. "No, this always goes away after you deliver." c. "Maybe, we have to wait and see at your 6-week postpartum checkup." d. "I don't know. But if you need medicine you should take it."

ANS: C Gestational hypertension can last after delivery. If it has not resolved by postpartum week 6, it is considered chronic, and the woman will probably have to take medication. It may or may not resolve, but the nurse should not provide false reassurance or state that he or she does not know without finding more information. Telling the woman to take medicine if she needs it belittles her concerns.

8. To initiate the milk ejection reflex, the mother should a. Wear a firm-fitting bra. b. Drink plenty of fluids. c. Place the infant to the breast d. Apply cool packs to her breast.

ANS: C Feedback A A firm bra is important to support the breast, but will not initiate the let-down reflex. B Drinking plenty of fluids is necessary for adequate milk production, but will not initiate the let-down reflex. C Oxytocin, which causes the milk let-down reflex, increases in response to nipple stimulation. D Cool packs to the breast will decrease the let-down reflex.

33. Two days ago, a woman gave birth to a full-term infant. Last night, she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is a. Elevated temperature caused by postpartum infection b. Increased basal metabolic rate after giving birth c. Loss of increased blood volume associated with pregnancy d. Increased venous pressure in the lower extremities

ANS: C Feedback A An elevated temperature causes chills and may cause dehydration, not diaphoresis and diuresis. B Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate. C Within 12 hours of birth, women begin to lose the excess tissue fluid that has accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid. D Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.

26. A newborn who is large for gestational age (LGA) is _____ percentile for weight. a. Below the 90th b. Less than the 10th c. Greater than the 90th d. Between the 10th and 90th

ANS: C Feedback A An infant between the 10th and 90th percentiles is average for gestational age. B An infant in less than the 10th percentile is small for gestational age. C The LGA rating is based on weight and is defined as greater than the 90th percentile in weight. D This infant is considered average for gestational age.

14. When the nurse is in the process of health teaching it is very important that he or she consider the family's cultural beliefs regarding child care. One of these beliefs includes a. Arab women are anxious to breastfeed while still in the hospital. b. It is important to complement Asian parents about their new baby. c. Women from India tie a black thread around the infant's waist. d. In the Korean culture the patient's mother is the primary caregiver of the infant.

ANS: C Feedback A Arab women are hesitant to breastfeed in the birth facility and wish to wait until they are home and their milk comes in. B Asian parents may be uneasy when caregivers are too complementary about the baby or casually touch the infant's head. C Women from India may tie a black thread around the infant's wrist, ankle, or waist to ward off evil spirits. This thread should not be removed by the nurse. D In the Korean culture, the husband's mother is the primary caregiver for the infant and the mother during the early weeks.

9. What is the first step in assisting the breastfeeding mother? a. Provide instruction on the composition of breast milk. b. Discuss the hormonal changes that trigger the milk ejection reflex. c. Assess the woman's knowledge of breastfeeding. d. Help her obtain a comfortable position and place the infant to the breast.

ANS: C Feedback A Assessment should occur before instruction. B This may be part of the instructional plan, but assessment should occur first to determine what instruction is needed. C The nurse should first assess the woman's knowledge and skill in breastfeeding to determine her teaching needs. D This may be part of the instructional plan, but assessment should occur first to determine what instruction is needed.

1. A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means. The nurse's best response is a. "You have pitting edema in your ankles." b. "You have deep tendon reflexes rated 2+." c. "You have calf pain when the nurse flexes your foot." d. "You have a 'fleshy' odor to your vaginal drainage."

ANS: C Feedback A Edema is within normal limits for the first few days until the excess interstitial fluid is remobilized and excreted. B Deep tendon reflexes should be 1+ to 2+. C Discomfort in the calf with sharp dorsiflexion of the foot may indicate a deep vein thrombosis. D A "fleshy" odor, not a foul odor, is within normal limits.

32. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman? a. Estrogen b. Progesterone c. Prolactin d. Human placental lactogen

ANS: C Feedback A Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. B Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. C Prolactin levels in the blood increase progressively throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth. D Human placental lactogen levels dramatically decrease after expulsion of the placenta.

8. A pregnant patient asks when the dark line on her abdomen (linea nigra) will go away. The nurse knows the pigmentation will decrease after delivery because of a. Increased estrogen b. Increased progesterone c. Decreased melanocyte-stimulating hormone d. Decreased human placental lactogen

ANS: C Feedback A Estrogen levels decrease after delivery. B Progesterone levels decrease after delivery. C Melanocyte-stimulating hormone increases during pregnancy and is responsible for changes in skin pigmentation; the amount decreases after delivery. D Human placental lactogen production continues to aid in lactation. However, it does not affect pigmentation.

29. What characteristic shows the greatest gestational maturity? a. Few rugae on the scrotum and testes high in the scrotum b. Infant's arms and legs extended c. Some peeling and cracking of the skin d. The arm can be positioned with the elbow beyond the midline of the chest

ANS: C Feedback A Few rugae on the scrotum show a younger age in the newborn. B Extended arms and legs is a sign of preterm infants. C Peeling, cracking, dryness, and a few visible veins in the skin are signs of maturity in the newborn. D This result of the scarf sign shows a younger newborn.

5. Which type of formula is not diluted before being administered to an infant? a. Powdered b. Concentrated c. Ready-to-use d. Modified cow's milk

ANS: C Feedback A Formula should be well mixed to dissolve the powder and make it uniform. B Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. C Ready-to-use formula can be poured directly from the can into baby's bottle and is good (but expensive) when a proper water supply is not available. D Cow's milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

19. In which infant behavioral state is bonding most likely to occur? a. Drowsy b. Active alert c. Quiet alert d. Crying

ANS: C Feedback A In the drowsy state the eyes may remain closed. If open they are unfocused. The infant is not interested in the environment at this time. B In the active alert state infants are often fussy, restless, and not focused. C In the quiet alert state, the infant is interested in his or her surroundings and will often gaze at the mother or father or both. D During the crying state the infant does not respond to stimulation and cannot focus on parents.

14. A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is a. Seen at age 3 days b. The residue of a milk curd c. Passed in the first 12 hours of life d. Lighter in color and looser in consistency

ANS: C Feedback A Meconium stool is the first stool of the newborn. B Meconium stool is made up of matter in the intestines during intrauterine life. C Meconium stool is usually passed in the first 12 hours of life and 99% of newborns have their first stool within 48 hours. If meconium is not passed by 48 hours, obstruction is suspected. D Meconium is dark in color and sticky.

24. A maculopapular rash with a red base and a small white papule in the center is a. Milia b. Mongolian spots c. Erythema toxicum d. Cafe-au-lait spots

ANS: C Feedback A Milia are minute epidermal cysts on the face of the newborn. B Mongolian spots are bluish-black discolorations found on dark-skinned newborns, usually on the sacrum. C This is a description of erythema toxicum, a normal rash in the newborn. D These spots are pale tan (the color of coffee with milk) macules. Occasional spots occur normally in newborns.

5. A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? a. Physiologic jaundice occurs during the first 24 hours of life. b. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types. c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life. d. This condition is also known as "breast milk jaundice."

ANS: C Feedback A Pathologic jaundice occurs during the first 24 hours of life. B Pathologic jaundice is caused by blood incompatibilities, causing excessive destruction of erythrocytes, and must be investigated. C Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dL or greater, which occurs when the baby is approximately 3 days old. This finding is within normal limits for the newborn. D Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.

9. As part of Standard Precautions, nurses wear gloves when handling the newborn. The chief reason is a. To protect the baby from infection b. It is part of the Apgar protocol c. To protect the nurse from contamination by the newborn d. Because the nurse has primary responsibility for the baby during the first 2 hours

ANS: C Feedback A Proper hand hygiene is all that is necessary to protect the infant from infection. B Wearing gloves is not necessary in order to complete the Apgar score assessment. C With the possibility of transmission of viruses such as HBV and HIV through maternal blood and amniotic fluid, the newborn must be considered a potential contamination source until proved otherwise. As part of Standard Precautions, nurses should wear gloves when handling the newborn until blood and amniotic fluid are removed by bathing. D The nurse assigned to the mother-baby couplet has primary responsibility regardless of whether or not she wears gloves.

11. What is a result of hypothermia in the newborn? a. Shivering to generate heat b. Decreased oxygen demands c. Increased glucose demands d. Decreased metabolic rate

ANS: C Feedback A Shivering is not an effective method of heat production for newborns. B Oxygen demands increase with hypothermia. C In hypothermia, the basal metabolic rate (BMR) is increased in an attempt to compensate, thus requiring more glucose. D The metabolic rate increases with hypothermia.

5. If the patient's white blood cell (WBC) count is 25,000/mm3 on her second postpartum day, the nurse should a. Tell the physician immediately. b. Have the laboratory draw blood for reanalysis. c. Recognize that this is an acceptable range at this point postpartum. d. Begin antibiotic therapy immediately.

ANS: C Feedback A Since this is a normal finding there is no reason to alert the physician. B There is no need for reassessment since it is expected for the WBCs to be elevated. C Marked leucocytosis occurs with WBC counts increasing to as high as 30,000/mm3during labor and the immediate postpartum period. The WBC falls to normal within 6 days postpartum. D Antibiotics are not needed because the elevated WBCs are due to stress of labor and not an infectious process.

25. A new mother wants to be sure that she is meeting her daughter's needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. The mother meets her child's needs when she a. Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition b. Warms the bottles using a microwave oven c. Burps her infant during and after the feeding as needed d. Refrigerates any leftover formula for the next feeding

ANS: C Feedback A Solid food should not be introduced to the infant for at least 4 to 6 months after birth. B A microwave should never be used to warm any food to be given to an infant. The heat is not distributed evenly, which may pose a risk of burning the infant. C Most infants swallow air when fed from a bottle and should be given a chance to burp several times during a feeding and after the feeding. D Any formula left in the bottle after the feeding should be discarded, because the infant's saliva has mixed with it.

10. With regard to lab tests and diagnostic tests in the hospital after birth, nurses should be aware that a. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases. b. Federal law prohibits newborn genetic testing without parental consent. c. If genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks. d. Hearing screening is now mandated by federal law.

ANS: C Feedback A States all test for PKU and hypothyroidism, but other genetic defects are not universally covered. B Federal law mandates newborn genetic screening; however, parents can decline testing. A waiver should be signed and a notation made in the infant's medical record. C If testing is done prior to 24 hours of age, genetic screening should be repeated when the infant is 1 to 2 weeks old. D Federal law does not mandate screening for hearing problems; however, the majority of states have enacted legislation mandating newborn hearing screening. In the U.S. the majority (95%) of infants are screened for hearing loss prior to discharge from the hospital.

6. To provide competent newborn care, the nurse understands that respirations are initiated at birth as a result of a. An increase in the PO2 and a decrease in PCO2 b. The continued functioning of the foramen ovale c. Chemical, thermal, sensory, and mechanical factors d. Drying off the infant

ANS: C Feedback A The PO2 decreases at birth and the PCO2 increases. B The foramen ovale closes at birth. C A variety of these factors are responsible for initiation of respirations. D Tactile stimuli aid in initiating respirations, but are not the main cause.

16. As the nurse assists a new mother with breastfeeding, she asks, "If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The nurse's best response is that it contains a. More calories b. Essential amino acids c. Important immunoglobulins d. More calcium

ANS: C Feedback A The calorie count of formula and breast milk is about the same. B All of the essential amino acids are in both formula and breast milk. The concentrations may differ. C Breast milk contains immunoglobulins that protect the newborn against infection. D Calcium levels are higher in formula than breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly.

1. A yellow crust has formed over the circumcision site. The mother calls the hotline at the local hospital, 5 days after her son was circumcised. She is very concerned. On which rationale should the nurse base her reply? a. After circumcision, the diaper should be changed frequently and fastened snugly. b. This yellow crust is an early sign of infection. c. The yellow crust should not be removed. d. Discontinue the use of petroleum jelly to the tip of the penis.

ANS: C Feedback A The diaper should be fastened loosely to prevent rubbing or pressure on the incision site. B The normal yellowish exudate that forms over the site should be differentiated from the purulent drainage of infection. C Crust is a normal part of healing. D The only contraindication for petroleum jelly is the use of a PlastiBell.

14. How many ounces will a formula fed infant who is on a 4-hour feeding schedule need to consume at each feeding to meet daily caloric needs? a. 0.5 to 1 b. 1 to 2 c. 2 to 3 d. 4

ANS: C Feedback A The infant takes 0.5 to 1 ounce per feeding during the first day of life. B This is too small an amount to meet calorie needs. C The newborn requires approximately 2 to 3 ounces per feeding within one week after birth. D Four ounces with every feeding would be overfeeding the infant.

17. Which statement is correct regarding the fluid balance in a newborn versus that in an adult? a. The infant has a smaller percentage of surface area to body mass. b. The infant has a smaller percentage of water to body mass. c. The infant has a greater percentage of insensible water loss. d. The infant has a 50% more effective glomerular filtration rate.

ANS: C Feedback A The infant's surface area is large compared to an adult's. B Infants have a larger percentage of water to body mass. C Insensible water loss is greater in the infant due to the newborn's large body surface area and rapid respiratory rate. D The filtration rate is less than in adults; the kidneys are immature in a newborn.

15. What documentation on a woman's chart on postpartum day 14 indicates a normal involution process? a. Moderate bright red lochial flow b. Breasts firm and tender c. Fundus below the symphysis and not palpable d. Episiotomy slightly red and puffy

ANS: C Feedback A The lochia should be changed by this day to serosa. B Breasts are not part of the involution process. C The fundus descends 1 cm/day, so by postpartum day 14 it is no longer palpable. D The episiotomy should not be red or puffy at this stage.

3. The normal term infant has little difficulty clearing its airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can easily be cleared with a bulb syringe. When instructing parents on the correct use of this piece of equipment, it is important that the nurse teach them to a. Avoid suctioning the nares. b. Insert the compressed bulb into the center of the mouth. c. Suction the mouth first. d. Remove the bulb syringe from the crib when finished.

ANS: C Feedback A The nasal passages should be suctioned one nostril at a time. The mouth should always be suctioned first. B After compression of the bulb it should be inserted into one side of the mouth. If it is inserted into the center of the mouth, the gag reflex is likely to be initiated. C The mouth should be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned. D When the infant's cry no longer sounds as though it is through mucus or a bubble, suctioning can be stopped. The bulb syringe should remain in the crib so that it is easily accessible if needed again.

10. While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is _____ beats/min. a. 80 to 100 b. 100 to 120 c. 120 to 160 d. 150 to 180

ANS: C Feedback A The newborn's heart rate may be about 85 to 100 beats/min while sleeping. B The infant's heart rate typically is a bit higher when alert but quiet. C The average infant heart rate while awake is 120 to 160 beats/min. D A heart rate of 150 to 180 beats/min is typical when the infant cries.

37. With regard to the newborn's developing cardiovascular system, nurses should be aware that a. The heart rate of a crying infant may rise to 120 beats/min. b. Heart murmurs heard after the first few hours are cause for concern. c. The point of maximal impulse (PMI) often is visible on the chest wall. d. Persistent bradycardia may indicate respiratory distress syndrome (RDS).

ANS: C Feedback A The normal heart rate for infants who are not sleeping is 120 to 160 beats/min. However, a crying infant temporarily could have a heart rate of 180 beats/min. B Heart murmurs during the first few days of life have no pathologic significance; an irregular heart rate past the first few hours should be evaluated further. C The newborn's thin chest wall often allows the PMI to be seen. D Persistent tachycardia may indicate RDS; bradycardia may be a sign of congenital heart blockage.

6. Postpartal overdistention of the bladder and urinary retention can lead to which complication? a. Postpartum hemorrhage and eclampsia b. Fever and increased blood pressure c. Postpartum hemorrhage and urinary tract infection d. Urinary tract infection and uterine rupture

ANS: C Feedback A There is no correlation between bladder distention and eclampsia. B There is no correlation between bladder distention and blood pressure or fevers. C Incomplete emptying and overdistention of the bladder can lead to urinary tract infection. Overdistention of the bladder displaces the uterus and prevents contraction of the uterine muscle. D The risk of uterine rupture decreases after the birth.

20. Heat loss by convection occurs when a newborn is a. Placed on a cold circumcision board b. Given a bath c. Placed in a drafty area of the room d. Wrapped in cool blankets

ANS: C Feedback A This is conduction. B This is evaporation. C Convection occurs when infants are exposed to cold air currents. D This is conduction.

13. In administering vitamin K to the infant shortly after birth, the nurse understands that vitamin K is a. Important in the production of red blood cells b. Necessary in the production of platelets c. Not initially synthesized because of a sterile bowel at birth d. Responsible for the breakdown of bilirubin and prevention of jaundice

ANS: C Feedback A Vitamin K is important for blood clotting. B The platelet count in term newborns is near adult levels. Vitamin K is necessary to activate prothrombin and other clotting factors. C The bowel is initially sterile in the newborn, and vitamin K cannot be synthesized until food is introduced into the bowel. D Vitamin K is necessary to activate the clotting factors.

8. The nurse administers vitamin K to the newborn for what reason? a. Most mothers have a diet deficient in vitamin K, which results in the infant's being deficient. b. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection. c. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. d. The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.

ANS: C Feedback A Vitamin K is provided because the newborn does not have the intestinal flora to produce this vitamin for the first week. The maternal diet has no bearing on the amount of vitamin K found in the newborn. B Vitamin K promotes the formation of clotting factors in the liver and is used for the prevention and treatment of hemorrhagic disease in the newborn. C This is an accurate statement. D Vitamin K is not produced in the intestinal tract of the newborn until after microorganisms are introduced. By day 8, normal newborns are able to produce their own vitamin K.

The student nurse is assessing a woman with abruptio placentae. The student reports to the registered nurse "I can't really palpate her abdomen, it's as hard as a board." What action by the nurse is the priority? a. Tell the student to document the findings. b. Have the student teach the woman relaxation techniques. c. Assess the woman's fundal height and vital signs. d. Administer a dose of opioid pain medication.

ANS: C A hard, board-like abdomen in this setting is characteristic of concealed hemorrhage. The nurse assesses the woman's fundal height (which will rise with bleeding) and vital signs to detect shock. Documentation occurs after interventions are complete. Relaxation techniques may help the woman cope with the situation, but anxiety is not the reason for the findings. The woman may or may not need pain medication, and if she is going to need surgery, she should not get opioids until consents are signed.

22. The nurse should suspect uterine rupture if a. fetal tachycardia occurs. b. the woman becomes dyspneic. c. contractions abruptly stop during labor. d. labor progresses unusually quickly.

ANS: C A large rupture of the uterus will disrupt its ability to contract. Fetal tachycardia is a sign of hypoxia. Dyspnea and unusually quick labor are not signs of rupture.

21. A woman who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is a. "Back pain is common at this time during pregnancy due to poor posture." b. "Acetaminophen is acceptable during pregnancy; however, do not take aspirin." c. "You should come into the office and let the doctor check you." d. "Try a warm bath or using a heating pad."

ANS: C A prolonged backache is one of the subtle symptoms of preterm labor. Early intervention may prevent preterm birth. The woman should be assessed before trying any home care measures.

14. When teaching the pregnant woman with class II heart disease, what information should the nurse provide? a. Advise her to gain at least 30 lb. b. Explain the importance of a diet high in calcium. c. Instruct her to avoid strenuous activity. d. Inform her of the need to limit fluid intake.

ANS: C Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept at a minimum with heart disease. Iron and folic acid intake is important to prevent anemia. Fluid intake should not be limited during pregnancy. She may also be put on a diuretic. Fluid intake is necessary to prevent fluid deficits.

19. Nursing measures that help prevent postpartum urinary tract infection include which of the following? a. Promoting bed rest for 12 hours after delivery b. Discouraging voiding until the sensation of a full bladder is present c. Forcing fluids to at least 3000 mL/day d. Encouraging the intake of orange, grapefruit, or apple juice

ANS: C Adequate fluid intake of 2500 to 3000 mL/day prevents urinary stasis, dilutes urine, and flushes out waste products. The woman should be encouraged to ambulate early. With pain medications, trauma to the area, and anesthesia, the sensation of a full bladder may be decreased. The woman needs to be encouraged to void frequently. Juices such as cranberry juice can discourage bacterial growth.

6. Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who a. want menstrual regularity and predictability. b. have a history of thrombotic problems or breast cancer. c. have difficulty remembering to take oral contraceptives daily. d. are homeless or mobile and rarely receive health care.

ANS: C Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are menstrual irregularities. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

7. Which patient is most at risk for fibroadenoma of the breast? a. A 38-year-old woman b. A 50-year-old woman c. A 16-year-old woman d. A 27-year-old woman

ANS: C Although it may occur at any age, fibroadenoma is most common in the teenage years.

9. After a birth complicated by a shoulder dystocia, what action by the nurse is most appropriate? a. Give supplemental oxygen with a small face mask. b. Encourage the parents to hold the infant. c. Palpate the infant's clavicles. d. Perform a complete newborn assessment.

ANS: C Because of the shoulder dystocia, the infant's clavicles may have been fractured. Palpation is a simple assessment to identify crepitus or deformity that requires follow-up. There is no indication for oxygen. The infant needs to be assessed for clavicle fractures before excessive movement. A complete newborn assessment is necessary for all newborns, but assessment of the clavicle is top priority for this infant.

18. What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord? a. Oligohydramnios b. Pregnancy at 38 weeks of gestation c. Presenting part at station -3 d. Meconium-stained amniotic fluid

ANS: C Because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture. Hydramnios puts the woman at high risk for a prolapsed umbilical cord. A very small fetus, normally preterm, puts the woman at risk for a prolapsed umbilical cord. Meconium-stained amniotic fluid shows that the fetus already has been compromised, but it does not increase the chance of a prolapsed cord.

A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a. vigorously stimulate the woman. b. instruct her to take deep breaths. c. administer calcium gluconate. d. increase her IV fluids.

ANS: C Calcium gluconate reverses the effects of magnesium sulfate. Stimulation, instruction on taking deep breaths, and increasing her fluid rate will not increase the respirations.

12. What is important in instructing a patient in the use of spermicidal foams or gels? a. Insert 1 to 2 hours before intercourse. b. One application is effective for several hours. c. Avoid douching for at least 6 hours. d. There are no known side effects.

ANS: C Douching within 6 hours of intercourse removes the spermicide and increases the risk of pregnancy. Foams or gels should be inserted just before intercourse and are effective for about 1 hour. Each application is effective for about 1 hour. Effectiveness is about 74% when used alone. Vaginal irritation may occur with spermicide use.

The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area? a. +1 edema b. +2 edema c. +3 edema d. +4 edema

ANS: C Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is termed +2 edema. Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity.

22. The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are a. a disease of the milk ducts and glands in the breasts. b. a pre-malignant disorder characterized by lumps found in the breast tissue. c. lumpiness with pain and tenderness found in the breasts of healthy women. d. lumpiness accompanied by tenderness after menses.

ANS: C Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with the menstrual cycle. Fibrocystic changes are palpable thickenings in the breast. Fibrocystic changes are not pre-malignant changes. This information is inaccurate. Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. Most often tenderness occurs prior to menses.

9. To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by doing which of the following? a. Eating six small equal meals per day b. Reducing carbohydrates in her diet c. Eating her meals and snacks on a fixed schedule d. Increasing her consumption of protein

ANS: C Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake or increased protein intake. Approximately 45% of the food eaten should be in the form of carbohydrates.

What is the only known cure for preeclampsia? a. Magnesium sulfate b. Antihypertensive medications c. Delivery of the fetus d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C If the fetus is viable and near term, delivery is the only known definitive treatment for preeclampsia. Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of ASA (81 mg) have been administered to women at high risk for developing preeclampsia.

1. The nurse is discussing infant care as part of the mother-infant's couplet discharge planning. The mother asks the nurse "When will my baby's cord fall off?" The nurse responds, "Your baby's cord should fall off by _______________ after birth."

ANS: 2 weeks Cord separation is influenced by several factors, including type of cord care, type of birth and other perinatal events. The average cord separation time is 10 to 14 days. Some dried blood may be seen at the umbilicus after separation.

1. The provider orders an infusion of magnesium sulfate to run at 4 g/hour. The pharmacy delivers a bag of 4 g magnesium sulfate in 250 mL. At what rate does the nurse set the pump? ___________________

ANS: 250 mL/hour 4 g/250 mL = 0.16 mg/mL 4/0.016 - 250 mL/hour

2. The nurse is performing a blood glucose test every 4 hours on an infant born to a diabetic mother. This is to assess the infant's risk of hypoglycemia. The nurse becomes concerned if the infant's blood glucose concentration falls below ______ mg/dl.

ANS: 40 If the newborn has a blood glucose level below 40 mg/dl intervention such as breastfeeding or bottle-feeding should be instituted. If levels remain low after this intervention an intravenous with dextrose may be warranted.

1. A newborn weight loss of _____% in a breastfeeding infant during the first 3 days of life should be investigated. Most often, the excessive weight loss is associated with poor breastfeeding techniques.

ANS: 7-8 Health care providers should evaluate and monitor infants who continue to lose weight after 5 days or who do not regain their birth weight by 14 days.

1. The acronym ________ is used as a reminder that the site of an episiotomy or perineal laceration should be assessed for five physical signs.

ANS: REEDA The acronym REEDA indicates redness, edema, ecchymosis or bruising, discharge, and approximation (the edges of the wound should be close). If redness is accompanied by pain or tenderness, this may indicate infection. Edema may illustrate soft tissue damage and delay wound healing. There should be no discharge. The edges of the wound should be closely approximated as if held together by glue.

3. A ________ succedaneum may appear over the vertex of the newborn's head as a result of pressure against the mother's cervix while in utero.

ANS: caput This pressure causes localized edema and appears as an edematous area on the infant's head. The edema may cross suture lines, is soft to the touch, and varies in size. It usually resolves quickly and disappears entirely within the first few days after birth. Caput may also occur as the result of an operative delivery when a vacuum extractor is used during a vaginal birth.

2. The process in which the uterus returns to a non-pregnant state after birth is known as __________.

ANS: involution This process begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle.

1. The shivering mechanism of heat production is rarely functioning in the newborn. Nonshivering _____________ is accomplished primarily by metabolism of brown fat, which is unique to the newborn, and by increased metabolic activity in the brain, heart, and liver.

ANS: thermogenesis Brown fat is located in superficial deposits in the interscapular region and axillae, as well as in deep deposits at the thoracic inlet, along the vertebral column and around the kidneys. Brown fat has a richer vascular and nerve supply than ordinary fat. Heat produced by intense lipid metabolic activity in brown fat can warm the newborn by increasing heat production by as much as 100%.

2. Milk that gradually changes from colostrum to mature milk, appears over about 10 days after delivery. This is known as _____________ milk.

ANS: transitional The amount of transitional milk increases rapidly as the milk comes in. Immunoglobulins and proteins decrease while lactose, fat, and calories increase.

23. During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby? a. Letting go b. Taking hold c. Taking in d. Taking on

ANS: A A Accepting the real infant and relinquishing the fantasy infant occurs during the letting-go phase of maternal adjustment. B During the taking-hold phase the mother assumes responsibility for her own care and shifts her attention to the infant. C In the taking-in phase the mother is primarily focused on her own needs. D There is no taking-on phase of maternal adjustment.

27. In providing support to a new mother who must return to full-time employment 6 weeks after a vaginal delivery, the nurse should a. Allow her to express her positive and negative feelings freely. b. Reassure her that she'll get used to leaving her baby. c. Discuss child care arrangements with her. d. Allow her to solve the problem on her own.

ANS: A A Allowing the patient to express feelings will provide positive support in her process of maternal adjustment. B This blocks communication and belittles the patient's feelings. C This is an important step in anticipatory guidance, but is not the best way to offer support. D She should be instrumental in solving the problem; however, allowing her time to express her feelings and talk the problem over will assist her in making this decision.

32. What is the quickest and most common method to obtain neonatal blood for glucose screening 1 hour after birth? a. Puncture the lateral pad of the heel. b. Obtain a sample from the umbilical cord. c. Puncture a fingertip. d. Obtain a laboratory chemical determination.

ANS: A Feedback A A drop of blood obtained by heel stick is the quickest method of glucose screening. The calcaneus bone should be avoided as osteomyelitis may result from injury to the foot. B Most umbilical cords are clamped in the delivery room and are not available for routine testing. C A neonate's fingertips are too fragile to use for this purpose. D Laboratory chemical determination is the most accurate but the lengthiest method.

19. A breastfeeding mother who was discharged yesterday calls to ask about a tender, hard area on her right breast. The nurse's first response should be a. "Try massaging the area and apply heat, as this is probably a plugged duct." b. "Stop breastfeeding because you probably have an infection." c. "Notify your doctor so he can start you on antibiotics." d. "This is a normal response in breastfeeding mothers."

ANS: A Feedback A A plugged lactiferous duct results in localized edema, tenderness, and a palpable hard area. Massage of the area followed by heat will cause the duct to open. B Fatigue, aching muscles, fever, chills, malaise, and headache are signs of mastitis. She may have a localized area of redness and inflammation. C These are not the signs of an infection, so antibiotics are not indicated. D This is a normal deviation but requires intervention to prevent further complications.

33. A new mother states that her infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called a. Acrocyanosis b. Erythema neonatorum c. Harlequin color d. Vernix caseosa

ANS: A Feedback A Acrocyanosis, or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. Acrocyanosis is normal and appears intermittently over the first 7 to 10 days. B Erythema toxicum (also called erythema neonatorum) is a transient newborn rash that resembles flea bites. C The harlequin sign is a benign, transient color change in newborns. Half of the body is pale, and the other half is ruddy or bluish red with a line of demarcation. D Vernix caseosa is a cheeselike, whitish substance that serves as a protective covering.

11. Rho immune globulin will be ordered postpartum if which situation occurs? a. Mother Rh-, baby Rh+ b. Mother Rh-, baby Rh- c. Mother Rh+, baby Rh+ d. Mother Rh+, baby Rh-

ANS: A Feedback A An Rh- mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. B The blood types are alike, so no antibody formation would be anticipated. C The blood types are alike, so no antibody formation would be anticipated. D If the Rh+ blood of the mother comes in contact with the Rh- blood of the infant, no antibodies would develop because the antigens are in the mother's blood, not the infant's.

9. The nurse should alert the physician when a. The infant is dusky and turns cyanotic when crying. b. Acrocyanosis is present at age 1 hour. c. The infant's blood glucose is 45 mg/dL. d. The infant goes into a deep sleep at age 1 hour.

ANS: A Feedback A An infant who is dusky and becomes cyanotic when crying is showing poor adaptation to extrauterine life. B Acrocyanosis is an expected finding during the early neonatal life. C This is within normal range for a newborn. D Infants enter the period of deep sleep when they are about 1 hour old.

4. Nurses can prevent evaporative heat loss in the newborn by a. Drying the baby after birth and wrapping the baby in a dry blanket b. Keeping the baby out of drafts and away from air conditioners c. Placing the baby away from the outside wall and the windows d. Warming the stethoscope and nurse's hands before touching the baby

ANS: A Feedback A Because the infant is a wet with amniotic fluid and blood, heat loss by evaporation occurs quickly. B Heat loss by convection occurs when drafts come from open doors and air currents created by people moving around. C If the heat loss is caused by placing the baby near cold surfaces or equipment, it is termed a radiation heat loss. D Conduction heat loss occurs when the baby comes in contact with cold objects or surfaces.

28. The best reason for recommending formula over breastfeeding is that a. The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. b. The mother lacks confidence in her ability to breastfeed. c. Other family members or care providers also need to feed the baby. d. The mother sees bottle-feeding as more convenient.

ANS: A Feedback A Breastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using/abusing drugs. B Some women lack confidence in their ability to produce breast milk of adequate quantity or quality. The key to encouraging these mothers to breastfeed is anticipatory guidance beginning as early as possible in pregnancy. C A major barrier for many women is the influence of family and friends. She may view formula feeding as a way to ensure that the father and other family members can participate. Each encounter with the family is an opportunity for the nurse to educate, dispel myths and clarify information regarding the benefits of breastfeeding. D Many women see bottle-feeding as more convenient and less embarrassing than breastfeeding. They may also see breastfeeding as incompatible with an active social life. There may be modesty issues related to feeding the infant in public. Although concerning, these are not legitimate reasons to formula-feed an infant. Often this decision is made without complete information regarding the benefits of breastfeeding.

26. According to the recommendations of the American Academy of Pediatrics (AAP) on infant nutrition a. Infants should be given only human milk for the first 6 months of life. b. Infants fed on formula should be started on solid food sooner than breastfed infants. c. If infants are weaned from breast milk before 12 months, they should receive cow's milk, not formula. d. After 6 months, mothers should shift from breast milk to cow's milk.

ANS: A Feedback A Breastfeeding/human milk should also be the sole source of milk for the second 6 months. B Infants start on solids when they are ready, usually at 6 months, whether they start on formula or breast milk. C If infants are weaned from breast milk before 12 months, they should receive iron-fortified formula, not cow's milk. D Breastfeeding/human milk should also be the sole source of milk for the second 6 months.

23. A new mother asks if she should feed her newborn colostrum, because it is not "real milk." The nurse's best answer is that a. Colostrum is high in antibodies, protein, vitamins, and minerals. b. Colostrum is lower in calories than milk and should be supplemented by formula. c. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. d. Colostrum is unnecessary for newborns.

ANS: A Feedback A Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. B Supplementation is not necessary. It will decrease stimulation to the breast and decrease the production of milk. C It is important for the mother to feel comfortable in this role before discharge, but the importance of the colostrum to the infant is top priority. D Colostrum provides immunities and enzymes necessary to clean the gastrointestinal system, among other things.

2. A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. Which statement is true? Bottle-feeding using commercially prepared infant formulas a. Increases the risk that the infant will develop allergies b. Helps the infant sleep through the night c. Ensures that the infant is getting iron in a form that is easily absorbed d. Requires that multivitamin supplements be given to the infant

ANS: A Feedback A Exposure to cow's milk poses a risk of developing allergies, eczema, and asthma. B This is a false statement. Newborns should be fed during the night regardless of feeding method. C Iron is better absorbed from breast milk than from formula. D Commercial formulas are designed to meet the nutritional needs of the infant and to resemble breast milk. No supplements are necessary.

22. Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. What statement is valid? a. A premature infant more easily digests breast milk than formula. b. A glass of wine just before pumping will help reduce stress and anxiety. c. The mother should only pump as much as the infant can drink. d. The mother should pump every 2 to 3 hours, including during the night.

ANS: A Feedback A Human milk is the ideal food for preterm infants, with benefits that are unique in addition to those received by term, healthy infants. Greater physiologic stability occurs with breastfeeding compared with formula feeding. B Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mother's milk ejection reflex. C To establish an optimal milk supply, the mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast. D The mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

17. The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to a. The positive feedback an infant exhibits toward parents during the attachment process b. Behavior during the sensitive period when the infant is in the quiet alert stage c. Unidirectional behavior exhibited by the infant, initiated and enhanced by eye contact d. Behavior by the infant during the sensitive period to elicit feelings of "falling in love" from the parents

ANS: A Feedback A In this definition, reciprocal refers to the feedback from the infant during the attachment process. B This is a good time for bonding, but it does not define reciprocal attachment. C Reciprocal attachment is not unidirectional. D Reciprocal attachment deals with feedback behavior and is not unidirectional.

29. The nurse providing couplet care should understand that nipple confusion results when a. Breastfeeding babies receive supplementary bottle feedings. b. The baby is weaned too abruptly. c. Pacifiers are used before breastfeeding is established. d. Twins are breastfed together.

ANS: A Feedback A Nipple confusion can result when babies go back and forth between bottles and breasts, especially before breastfeeding is established in 3 to 4 weeks, because the two require different skills. B Abrupt weaning can be distressing to mother and/or baby but should not lead to nipple confusion. C Pacifiers used before breastfeeding is established can be disruptive, but this does not lead to nipple confusion. D Breastfeeding twins require some logistical adaptations, but this should not lead to nipple confusion.

28. Which nursing action is designed to avoid unnecessary heat loss in the newborn? a. Place a blanket over the scale before weighing the infant. b. Maintain room temperature at 70° F. c. Undress the infant completely for assessments so they can be finished quickly. d. Take the rectal temperature every hour to detect early changes.

ANS: A Feedback A Padding the scale prevents heat loss from the infant to a cold surface by conduction. B Room temperature should be appropriate to prevent heat loss from convection. Also, if the room is warm enough, radiation will assist in maintaining body heat. C Undressing the infant completely will expose the child to cooler room temperatures and cause a drop in body temperature due to convection. D Hourly assessments are not necessary for a normal newborn with a stable temperature.

11. Nurses can help parents deal with the issue and fact of circumcision if they explain a. The pros and cons of the procedure during the prenatal period b. That the American Academy of Pediatrics (AAP) recommends that all newborn males be routinely circumcised c. That circumcision is rarely painful and that any discomfort can be managed without medication d. That the infant will likely be alert and hungry shortly after the procedure

ANS: A Feedback A Parents need to make an informed choice regarding newborn circumcision based on the most current evidence and recommendations. Health care providers and nurses who care for childbearing families should provide factual, unbiased information regarding circumcision and give parents opportunities to discuss the risks and benefits of the procedure. B The AAP and other professional organizations note the benefits, but stop short of recommendation for routine circumcision. C Circumcision is painful and must be managed with environmental, nonpharmacologic, and pharmacologic measures. D Circumcision is painful and must be managed with environmental, nonpharmacologic, and pharmacologic measures.

7. In fetal circulation, the pressure is greatest in the a. Right atrium b. Left atrium c. Hepatic system d. Pulmonary veins

ANS: A Feedback A Pressure in fetal circulation is greatest in the right atrium, which allows a right-to-left shunting that aids in bypassing the lungs during intrauterine life. B The pressure increases in the left atrium after birth and will close the foramen ovale. C The liver does not filter the blood during fetal life until the end. It is functioning by birth. D Blood bypasses the pulmonary vein during fetal life.

22. Which newborn reflex is elicited by stroking the lateral sole of the infant's foot from the heel to the ball of the foot? a. Babinski b. Tonic neck c. Stepping d. Plantar grasp

ANS: A Feedback A The Babinski reflex causes the toes to flare outward and the big toe to dorsiflex. B The tonic neck reflex (also called the fencing reflex) refers to the posture assumed by newborns when in a supine position. C The stepping reflex occurs when infants are held upright with their heel touching a solid surface and the infant appears to be walking. D Plantar grasp reflex is similar to the palmar grasp reflex: when the area below the toes are touched, the infant's toes curl over the nurse's finger.

2. Which woman is most likely to have severe afterbirth pains and request a narcotic analgesic? a. Gravida 5, para 5 b. Woman who is bottle-feeding her first child c. Primipara who delivered a 7-lb boy d. Woman who wishes to breastfeed as soon as her baby is out of the neonatal intensive care unit

ANS: A Feedback A The discomfort of afterpains is more acute for multiparas because repeated stretching of muscle fibers leads to loss of uterine muscle tone. B Afterpains are particularly severe during breastfeeding, not bottle-feeding. C The uterus of a primipara tends to remain contracted. D The nonnursing mother may have engorgement problems. She should empty her breasts regularly to stimulate milk production so she will have the milk when the baby is strong enough to nurse.

4. Which finding 12 hours after birth requires further assessment? a. The fundus is palpable two fingerbreadths above the umbilicus. b. The fundus is palpable at the level of the umbilicus. c. The fundus is palpable one fingerbreadth below the umbilicus. d. The fundus is palpable two fingerbreadths below the umbilicus.

ANS: A Feedback A The fundus rises to the umbilicus after delivery and remains there for about 24 hours. A fundus that is above the umbilicus may indicate uterine atony or urinary retention. B This is an appropriate assessment finding for 12 hours postpartum. C This is an appropriate assessment finding for 12 hours postpartum. D This is an unusual finding for 12 hours postpartum, but still appropriate.

15. Nursing follow-up care often includes home visits for the new mother and her infant. Which information related to home visits is correct? a. Ideally the visit is scheduled between 24 and 72 hours after discharge. b. Home visits are available in all areas. c. Visits are completed within a 30-minute time frame. d. Blood draws are not a part of the home visit.

ANS: A Feedback A The home visit is ideally scheduled during the first 24 to 72 hours after discharge. This timing allows early assessment and intervention for problems with feedings, jaundice, newborn adaptation, and maternal-infant interaction. B Because home visits are expensive, they are not available in all geographic areas. C Visits are usually 60 to 90 minutes in length to allow enough time for assessment and teaching. D When jaundice is found, the nurse can discuss the implications and check the transcutaneous bilirubin level or draw blood for testing.

30. Many types of breast pumps are available, varying in price and effectiveness. Before either renting or purchasing a pump, the new mother would benefit from counseling by a nurse or lactation consultant to determine the most appropriate pump to suit her needs. The mother who is pumping for an occasional bottle would be most suited for which type of pump? a. Manual or hand pump b. Hospital grade pump c. Electric self-cycling double pumps d. Smaller electric or battery operated pump

ANS: A Feedback A These are the least expensive and can be the most appropriate choice for mothers pumping for the occasional bottle. B Full service electric or hospital grade pumps most closely duplicate the sucking action of the breastfeeding infant. These are used when mother and baby (preterm or sick) are separated for long periods. C Self-cycling pumps are easy to use, efficient and designed for working mothers. D Smaller pumps operated with a battery are typically used when pumping occasionally.

35. A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, "What is this black, sticky stuff in her diaper?" The nurse's best response is a. "That's meconium, which is your baby's first stool. It's normal." b. "That's transitional stool." c. "That means your baby is bleeding internally." d. "Oh, don't worry about that. It's okay."

ANS: A Feedback A This is an accurate statement and the most appropriate response. B Transitional stool is greenish brown to yellowish brown and usually appears by the third day after initiation of feeding. C This statement is not accurate. D This statement is not appropriate. It is belittling to the father and does not educate him about the normal stool patterns of his daughter.

38. The cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating is called a. Vernix caseosa b. Surfactant c. Caput succedaneum d. Acrocyanosis

ANS: A Feedback A This protection is needed because the infant's skin is so thin. B Surfactant is a protein that lines the alveoli of the infant's lungs. C Caput succedaneum is the swelling of the tissue over the presenting part of the fetal head. D Acrocyanosis is cyanosis of the hands and feet, resulting in a blue coloring.

8. Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? a. Incomplete uterine relaxation b. Maternal fatigue and exhaustion c. Maternal sedation with narcotics d. Administration of tocolytic drugs

ANS: A A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. Maternal fatigue or sedation does not decrease uterine blood flow. Tocolytic drugs decrease contractions. This will increase uterine blood flow.

25. What risk factor for peripartum depression (PPD) is likely to have the greatest effect on the woman's condition? a. Personal history of depression b. Single-mother status c. Low socioeconomic status d. Unplanned or unwanted pregnancy

ANS: A A personal history of depression is a known risk factor for peripartum depression. Being single, from a low socioeconomic status, or having an unplanned or unwanted pregnancy may contribute to depression for some women but are not strong predictors.

20. A couple are asking the nurse about in vitro fertilization. What explanation by the nurse is best? a. "IVF places the product of conception from your sperm and her egg into the uterus." b. "A donor embryo will be transferred into your wife's uterus." c. "Donor sperm will be used to inseminate your wife." d. "Don't worry about the technical stuff; that's what we are here for."

ANS: A A woman's eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred. There are no donors involved in this specific type of assisted reproductive technology although if the process does not work due to problems with either the man or the woman, donor products can be used. Telling the couple to not worry about the technical aspects of the treatment does not offer them any information and belittles their questions and concerns.

A nurse is assessing a woman receiving magnesium sulfate. The nurse assesses her deep tendon reflexes at 0 and 1+. What action by the nurse is best? a. Hold the magnesium sulfate. b. Ask the provider to order a 24-hour UA. c. Assess the woman's temperature. d. Take the woman's blood pressure.

ANS: A Absent or hypoactive deep tendon reflexes are indicative of magnesium sulfate toxicity. The nurse should hold the magnesium and notify the provider. There is no need for a 24- hour UA at this point. Temperature changes are not related to magnesium. Blood pressure can be assessed, but that is not the priority.

The nursing student learns that spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. no evidence exists of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of a fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection.

13. A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to a. stimulate fetal surfactant production. b. reduce maternal and fetal tachycardia associated with ritodrine administration. c. suppress uterine contractions. d. maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

ANS: A Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.

The nurse learns that which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors

ANS: A Around 60% of pregnancy losses from spontaneous abortion in the first trimester result from chromosomal abnormalities that are incompatible with life. Maternal infection, endocrine imbalances, and immunologic factors may also be causes of early miscarriage.

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. assess fetal heart rate (FHR) and maternal vital signs. b. perform a venipuncture for hemoglobin and hematocrit levels. c. place clean disposable pads to collect any drainage. d. monitor uterine contractions.

ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The blood levels can be obtained later. It is important to assess future bleeding and provide for comfort, but the top priority is mother/fetal well-being. Monitoring uterine contractions is important but not the top priority.

23. A student nurse is preparing to administer a dose of betamethasone. What action by the student warrants intervention by the registered nurse? a. Starts a separate IV line to infuse the medication b. Tells the woman her blood glucose will be monitored more often c. Prepares an IM injection choosing a 1 1 2 ́ needle d. Listens to the woman's lungs prior to administering the medication

ANS: A Betamethasone is given in two IM injections with the appropriate needle. When the student begins to insert a dedicated line for administering it, the nurse intervenes to stop this incorrect action. Since this drug is a steroid, blood glucose readings can rise, so diabetic patients will have more frequent blood sugars. Pulmonary edema is uncommon, but the astute nurse (or student) will listen to lung sounds prior to administration for a baseline.

4. Birth for the nulliparous woman with a fetus in a breech presentation is usually by a. cesarean delivery. b. vaginal delivery. c. forceps-assisted delivery. d. vacuum extraction.

ANS: A Delivery for the nulliparous woman with a fetus in breech presentation is almost always cesarean section. The greatest fetal risk in the vaginal delivery of breech presentation is that the head (largest part of the fetus) is the last to be delivered. The delivery of the rest of the baby must be quick so that the infant can breathe.

26. A woman has been admitted to the labor and delivery unit who is HIV positive. She is in active labor. What action by the nurse is most appropriate? a. Prepare to administer IV zidovudine. b. Place the mother on contact precautions. c. Administer oxygen by face mask. d. Notify social services.

ANS: A During labor, an IV infusion of zidovudine is administered. The woman does not need contact precautions; standard precautions suffice. The woman does not need oxygen because of her HIV status. There is no reason to notify social services.

20. Which measure may prevent mastitis in the breastfeeding mother? a. Initiating early and frequent feedings b. Nursing the infant for 5 minutes on each breast c. Wearing a tight-fitting bra d. Applying ice packs before feeding

ANS: A Early and frequent feedings prevent stasis of milk, which contributes to engorgement and mastitis. Five minutes does not adequately empty the breast. This will produce stasis of the milk. A firm-fitting bra will support the breast but not prevent mastitis. The breast should not be bound. Warm packs before feeding will increase the flow of milk.

9. What does the nurse know about postcoital emergency contraception with Ella or Next Choice? a. Requires that the first dose be taken within 72 hours of unprotected intercourse b. Requires that the woman take second and third doses at 24 and 36 hours after the first dose c. Must be taken in conjunction with an IUD insertion d. Most states require the woman to have a valid prescription

ANS: A Emergency contraception is most effective when used within 72 hours of intercourse but may be used with lessened effectiveness up to 120 hours later. Insertion of the copper IUD within 5 days of intercourse may also be used and is up to 99% effective. Emergency contraception is available without a prescription for women over 17 and for those younger than 17 with prescription.

1. The conscious decision on when to conceive or avoid pregnancy throughout the reproductive years is called a. family planning. b. birth control. c. contraception. d. assisted reproductive therapy.

ANS: A Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy is one of several possible treatments for infertility.

Rh incompatibility can occur if the woman is Rh negative and her a. fetus is Rh positive. b. husband is Rh positive. c. fetus is Rh negative. d. husband and fetus are both Rh negative.

ANS: A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh negative, the blood types are compatible and no problems should occur. If the fetus is Rh negative, the blood type with the mother is compatible. The husband's blood type does not enter into the problem.

6. A benign breast condition that includes dilation and inflammation of the collecting ducts is called a. ductal ectasia. b. intraductal papilloma. c. chronic cystic disease. d. fibroadenoma.

ANS: A Generally occurring in women approaching menopause, ductal ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated. Fibroadenoma is fibrous and glandular tissue. They are felt as firm, rubbery, and freely mobile nodules.

2. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states a. "I will need to increase my insulin dosage during the first 3 months of pregnancy." b. "Insulin dosage will likely need to be increased during the second and third trimesters." c. "Episodes of hypoglycemia are more likely to occur during the first 3 months." d. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding."

ANS: A Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin. Also the woman may be experiencing nausea, vomiting, and anorexia that would decrease her insulin needs. The other statements show good understanding of this topic.

18. With regard to anemia, nurses should be aware that a. it is the most common medical disorder of pregnancy. b. it can trigger reflex brachycardia. c. the most common form of anemia is caused by folate deficiency. d. thalassemia is a European version of sickle cell anemia.

ANS: A Iron deficiency anemia causes 75% of anemias in pregnancy. It is difficult to meet the pregnancy needs for iron through diet alone. It does not cause bradycardia. Thalassemia is a distinct disease from sickle cell anemia.

16. To assist the woman in regaining control of the urinary sphincter, the nurse should teach her to a. practice Kegel exercises. b. void every hour while awake. c. allow the bladder to become full before voiding. d. restrict fluids to limit incontinent episodes.

ANS: A Kegel exercises, tightening and relaxing the pubococcygeal muscle, will improve control of the urinary sphincter. Voiding every hour is too frequent and not realistic. Overdistention of the bladder will contribute to incontinence. Restricting fluids will cause bladder irritation that increases the problem.

3. Which technique is least effective for the woman with persistent occiput posterior position? a. Lie supine and relax. b. Sit or kneel, leaning forward with support. c. Rock the pelvis back and forth while on hands and knees. d. Squat.

ANS: A Lying supine increases the discomfort of "back labor." A sitting or kneeling position may help the fetal head to rotate to occiput anterior. Rocking the pelvis encourages rotation from occiput posterior to occiput anterior. Squatting aids both rotation and fetal descent.

22. A woman has been prescribed metformin at the infertility clinic. She says "Why am I on this? I am not a diabetic; my sister takes it for her diabetes!" What response by the nurse is best? a. "It is used to promote ovulation in polycystic ovary disease." b. "It will prevent your body from forming antibodies to sperm." c. "It helps prepare the uterine lining for eventual implantation." d. "I don't know but I will find out and let you know right away."

ANS: A Metformin is used as an adjunctive therapy to promote ovulation in the woman with polycystic ovary disease. It does not prevent antibody formation or prepare the uterine lining. The nurse should know this information but if he or she does not know, finding out and telling the woman as soon as possible would be the correct response.

12. The nurse should expect medical intervention for subinvolution to include a. oral methylergonovine maleate (Methergine) for 48 hours. b. oxytocin intravenous infusion for 8 hours. c. oral fluids to 3000 mL/day. d. intravenous fluid and blood replacement.

ANS: A Methergine provides long-sustained contraction of the uterus and is the usual treatment. Oxytocin and oral fluids are not used for this condition. There is no indication that blood loss has occurred in this situation; if it does blood replacement may be necessary.

32. A postmenopausal woman who is 54 years old has been diagnosed with two leiomyomas. What assessment finding is most commonly associated with the presence of leiomyomas? a. Abnormal uterine bleeding b. Diarrhea c. Weight loss d. Acute abdominal pain

ANS: A Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas, or fibroids. Diarrhea, weight loss, and acute abdominal pain are not characteristic of fibroids.

3. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. macrosomia. b. congenital anomalies of the central nervous system. c. preterm birth. d. low birth weight.

ANS: A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman.

12. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios rarely occurs in diabetic pregnancies. c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. Women should not use insulin pumps during pregnancy.

ANS: A Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios is a potential complication for the diabetic pregnancy. Infections are more common and more serious in pregnant women with diabetes. Women who were treated with an insulin pump before pregnancy can continue this therapy.

15. Prophylaxis of subacute bacterial endocarditis (SBE) is given before and after birth when a pregnant woman has a. valvular disease. b. congestive heart disease. c. dysrhythmias. d. postmyocardial infarction.

ANS: A Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse. It is not indicated for congestive heart failure, dysrhythmias, or myocardial infarctions.

26. The maternity nurse knows that which disorder can be triggered by a birth the woman views as traumatic? a. A phobia b. Panic disorder c. Posttraumatic stress disorder (PTSD) d. Obsessive-compulsive disorder (OCD)

ANS: C In PTSD, women perceive childbirth as a traumatic event. They have nightmares and flashbacks about the event, anxiety, and avoidance of reminders of the traumatic event. This will not lead to phobias, panic disorder, or OCD.

20. A woman who delivered her third child yesterday has just learned that her two school-age children have contracted chickenpox. What action by the nurse is best? a. Assess if the woman has had chickenpox or been vaccinated. b. Tell her that the baby has immunity from her and is not susceptible. c. Advise her if she is non-immune, she will get vaccinated at her 2-week postpartum checkup. d. The infant will receive prophylactic acyclovir before discharge.

ANS: A The first thing the nurse should do is to determine the woman's susceptibility to this infection. If she is non-immune, she will get her first vaccination prior to discharge. The nurse does not know the baby's immune status without knowing the mother's. Acyclovir is not used to treat chickenpox.

17. A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. Which response by the nurse is most appropriate? a. "This is a legitimate concern. Would you like to discuss this further before your treatment begins?" b. "No one has ever had more than triplets with Clomid." c. "Ovulation will be monitored with ultrasound so that this will not happen." d. "That has a very low chance of happening, so you don't need to worry too much."

ANS: A The incidence of multiple pregnancies with the use of these medications is increased. The patient's concern is legitimate and should be discussed so that she can make an informed decision. Women have had more that triplets on this medication. Ultrasound cannot prevent multiple gestation. Telling the woman not to worry is belittling her concerns.

17. The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by a. subinvolution of the uterus. b. defective vascularity of the decidua. c. cervical lacerations. d. coagulation disorders.

ANS: A The most common causes of late postpartum hemorrhage are subinvolution and retained placental fragments.

30. A woman is 6 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the first trimester is a. administration of prostaglandins. b. dilation and evacuation. c. intravenous administration of Pitocin. d. vacuum aspiration.

ANS: A The most common technique for medical termination of a pregnancy within the first 7 weeks of pregnancy is administration of prostaglandins. D&C is the most common method of surgical abortion used if medical abortion fails. Pitocin would not be used. Vacuum aspiration is used in the first trimester.

6. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypobilirubinemia d. Hypoinsulinemia

ANS: A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate's circulation, which results in hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia.

5. Early postpartum hemorrhage is defined as signs and symptoms of hypovolemia with which of the following descriptions of blood loss? a. Cumulative blood loss >1000 mL in the first 24 hours after the birth process. b. 750 mL in the first 24 hours after vaginal delivery c. Cumulative blood loss >1000 mL in the first 48 hours after the birth process d. 1500 mL in the first 48 hours after cesarean delivery

ANS: A The newest definition of early postpoartum hemorrhage is cumulative blood loss >1000 mL with signs of hypovolemia within the first 24 hours after the birth process. Hemorrhage after 24 hours is considered late postpartum hemorrhage.

23. A nurse has taught a pregnant woman about toxoplasmosis. What statement by the patients indicates a need for further instruction? a. "I will be certain to empty the litter boxes regularly." b. "I won't eat raw eggs." c. "I had better wash all of my fruits and vegetables." d. "I need to be cautious when cooking meat."

ANS: A The patient should avoid contact with materials that are possibly contaminated with cat feces while pregnant. This includes cat litter boxes, sand boxes, and garden soil. She should wash her hands thoroughly after working with soil or handling animals. The other statements show good understanding.

22. A woman has tested human immunodeficiency virus (HIV)-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis? a. "Even though my test is positive, my baby might not be affected." b. "I know I will need to have an abortion as soon as possible." c. "This pregnancy will probably decrease the chance that I will develop AIDS." d. "My baby is certain to have AIDS and die within the first year of life."

ANS: A The rate of perinatal transmission of HIV has decreased with the use of antiretroviral medications during pregnancy. There is no need to have an abortion. The mother may or may not go on to develop AIDS.

What order should the nurse expect for a patient admitted with a threatened abortion? a. Abstinence from sexual activity b. Pitocin IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A The woman may be counseled to avoid sexual activity with a threatened abortion. Activity restrictions were once recommended, but they have not shown effectiveness as treatment. Pitocin would be contraindicated. There is no reason for the woman to be NPO. In fact, hydration is important. Narcotic analgesia is not indicated.

10. A pregnant diabetic woman is in the hospital and her blood glucose reading is 42 mg/dL. What action by the nurse is best? a. Provide her with 15 grams of oral carbohydrate if she can swallow. b. Administer a bolus of rapid-acting insulin. c. Order the woman a meal tray from the cafeteria. d. Notify the provider immediately.

ANS: A This woman has hypoglycemia and needs to injest 15 grams of carbohydrate if she is able to swallow. Insulin would make the problem worse. The meal tray is a good idea but not as the first response as it will take too long. The provider should be notified but only after the nurse takes corrective action.

2. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is a. uterine atony. b. uterine inversion. c. vaginal hematoma. d. vaginal laceration.

ANS: A Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. The other situations can cause bleeding but are not the most common cause.

13. A 70-year-old woman should be taught to report what condition to her health care provider? a. Vaginal bleeding b. Pain with intercourse c. Breasts become smaller d. Skin becomes thinner

ANS: A Vaginal bleeding after menopause should always be investigated. It is highly suggestive of endometrial cancer. The other conditions are related to aging.

27. When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse should include the risks of a. breast cancer. b. vaginal and urinary tract atrophy. c. osteoporosis. d. arteriosclerosis.

ANS: A Women with a high risk of breast cancer should be counseled against using ERT. Estrogen prevents atrophy of vaginal and urinary tract tissue and protects against the development of osteoporosis. Estrogen has a favorable effect on circulating lipids, reducing low-density lipoprotein (LDL) and total cholesterol and increasing high-density lipoprotein (HDL). It also has a direct antiatherosclerotic effect on the arteries.

5,000 worth of toys e. Mother states birth was very traumatic

ANS: A, B Postpartum OCD often manifests with women performing obsessive behaviors and voicing fear of being left alone with their baby. Feeling worthless is a sign of depression. A spending spree might be a sign of the manic phase of bipolar disease. Viewing the birth as traumatic may lead to PTSD.

2. Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (select all that apply) a. Unwrap the infant. b. Change the diaper. c. Talk to the infant. d. Slap the infant's hands and feet. e. Apply a cold towel to the infant's abdomen.

ANS: A, B, C Feedback Correct These are appropriate techniques to use when trying to wake a sleepy infant. Incorrect This is not appropriate. The parent can rub the infant's hands or feet to wake the infant. Applying a cold towel to the infant's abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infant's face to wake the infant.

2. Congenital anomalies can occur with the use of antiepileptic drugs, including (Select all that apply.) a. Craniofacial abnormalities b. Congenital heart disease c. Neural tube defects d. Gastroschisis e. Diaphragmatic hernia

ANS: A, B, C Congenital anomalies that can occur with antiepileptic drugs include craniofacial abnormalities, congenital heart disease, and neural tube defects. They are not known to cause gastroschisis or diaphragmatic hernias.

1. Pain should be assessed regularly in all newborn infants. If the infant is displaying physiologic or behavioral cures indicating pain, measures should be taken to manage the infant's pain. Examples of nonpharmacologic pain management techniques include (select all that apply) a. Swaddling b. Nonnutritive sucking (pacifier) c. Skin-to-skin contact with the mother d. Sucrose e. Acetaminophen

ANS: A, B, C, D Feedback Correct These interventions are all appropriate nonpharmacologic techniques used to manage pain in neonates. Other interventions include soothing music, dim lighting and speaking to the infant in a quiet voice. Incorrect Acetaminophen is a pharmacologic method of treating pain.

2. Which medications can be taken by postmenopausal women to treat and/or prevent osteoporosis? (Select all that apply.) a. Calcium b. Evista c. Fosamax d. Actonel e. Vitamin C

ANS: A, B, C, D Calcium, Evista, Fosamax, and Actonel are all used to prevent or treat osteoporosis. Vitamin C is not.

3. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion? Select all that apply. a. Breast tenderness b. Warmth in the breast c. An area of redness on the breast often resembling the shape of a pie wedge d. A small white blister on the tip of the nipple e. Fever and flulike symptoms

ANS: A, B, C, E Feedback Correct These symptoms are commonly associated with mastitis and should be included in the nurse's discussion of mastitis. Incorrect This symptom generally is not associated with mastitis. It is commonly seen in women who have a plugged milk duct.

2. What actions can the labor and delivery nurse take to decrease a woman's chance of contracting a puerperal infection? (Select all that apply.) a. Avoid straight catheterizing the woman unless she cannot void. b. Keep vaginal examinations to a minimum. c. Change wet peripads and linens frequently. d. Maintain the woman on bedrest while laboring. e. Use good hand hygiene before and after contact with the woman.

ANS: A, B, C, E Risk for infection increases with catheterization, vaginal examinations, exposure to wet linens and pads, and poor hand hygiene. Remaining on bedrest does not reduce the chance for infection.

1. The student nurse learns that maternal complications of diabetes include which of the following? (Select all that apply.) a. Atherosclerosis b. Retinopathy c. IUFD d. Nephropathy e. Caudal regression syndrome

ANS: A, B, D Maternal complications of diabetes include heart disease, retinopathy, nephropathy, and neuropathy. Stillbirth and caudal regression syndrome are fetal complications.

1. Medications used to manage postpartum hemorrhage include which of the following? (Select all that apply.) a. Oxytocin b. Methergine c. Terbutaline d. Hemabate e. Magnesium sulfate

ANS: A, B, D Pitocin, Methergine, and Hemabate are all used to manage PPH. Terbutaline and magnesium sulfate are tocolytics; relaxation of the uterus causes or worsens PPH.

1. Women are often reluctant to have annual mammograms for many reasons. These reasons include which of the following? (Select all that apply.) a. Reluctance to hear bad news b. Fear of x-ray exposure c. Belief that lack of family history makes this test unnecessary d. Expense of the procedure e. Having heard that the test is painful

ANS: A, B, D, E Common reasons women give for postponing or avoiding mammography include reluctance to hear bad news, fears of x-ray exposure, and fear of pain. Some women may believe their family history makes it unnecessary, but this is not a common statement. Expense may be an issue for some women, but hopefully with the Affordable Care Act, the number of women worried about expense is declining.

The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Early signs of ectopic pregnancy include pelvic pain, abdominal pain, spotting or light bleeding, and a woman's report of a "missed period." Heavy bleeding is a later sign and occurs after the tube has ruptured.

3. The nurse explain to the student that which of the following factors increase a woman's risk for thrombosis? (Select all that apply.) a. Use of stirrups for a prolonged period of time b. Prolonged bedrest during or after labor and delivery c. Adherence to a strict vegetarian diet d. Excessive sweating during labor e. Maternal age greater than 30 years of age

ANS: A, B, D, E Use of stirrups for a prolonged period of time, bedrest, excessive sweating (leading to dehydration) all increase the risk of thrombosis. Vegetarian diets are not related. Maternal age >35 increases the risk.

2. What are the priority nursing assessments for a woman receiving tocolytic therapy with terbutaline? (Select all that apply.) a. Fetal heart rate b. Maternal heart rate c. Intake and output d. Maternal blood glucose e. Maternal blood pressure f. Odor of amniotic fluid

ANS: A, B, E All assessments are important, but those most relevant to the medication include the fetal heart rate and maternal pulse, which tend to increase, and the maternal blood pressure, which tends to exhibit a wide pulse pressure. The other assessments are important but not related to this medication.

2. As recently as 2005, the American Academy of Pediatrics revised safe sleep practices to assist in the prevention of sudden infant death syndrome. The nurse should model these practices in hospital and incorporate this information into the teaching for new parents. They include (select all that apply) a. Fully supine position for all sleep b. Side-sleeping position as an acceptable alternative c. "Tummy time" for play d. Placing the infant's crib in the parents' room e. A soft mattress

ANS: A, C, D Feedback Correct The back to sleep position is now recommended as the only position for every sleep period. To prevent positional plagiocephaly (flattening of the head) the infant should spend time on his or her abdomen while awake and for play. Loose sheets and blankets may be dangerous because they could easily cover the baby's head. The parents should be instructed to tuck any bedding securely around the mattress or use sleep sacks or bunting bags instead. Ideally the infant's crib should be placed in the parents' room. Incorrect The side-sleeping position is no longer an acceptable alternative according to the AAP. Infants should always sleep on a firm surface, ideally a firm crib mattress covered by a sheet only. Quilts, sheepskins, etc., should not be placed under the infant.

3. Hearing loss occurs in 9% of newborns. Auditory screening of all newborns within the first month of life is recommended by the American Academy of Pediatrics. Reasons for having this testing performed include (select all that apply) a. To prevent or reduce developmental delay b. Reassurance for concerned new parents c. Early identification and treatment d. To help the child communicate better e. To achieve one of the Healthy People 2020 goals

ANS: A, C, D, E Feedback Correct These are all appropriate reasons for auditory screening of the newborn. Infants who do not pass should be rescreened. If they still do not pass the test, they should have a full audiologic and medical evaluation by 3 months of age. If necessary, the infant should be enrolled in early intervention by 6 months of age. Incorrect New parents are often anxious regarding this test and the impending results; however, it is not the reason for the screening to be performed. Auditory screening is usually done before hospital discharge. It is important for the nurse to ensure that the infant receives the appropriate testing and that the test is fully explained to the parents. For infants that are referred for further testing and follow-up, it is important for the nurse to provide further explanation and emotional support.

3. The student nurse learns that maternal risks of systemic lupus erythematosus include (Select all that apply.) a. Premature rupture of membranes (PROM) b. Fetal death resulting in stillbirth c. Hypertension d. Preeclampsia e. Renal complications

ANS: A, C, D, E PROM, hypertension, preeclampsia, and renal complications are all maternal risks associated with SLE. Stillbirth and prematurity are fetal risks of SLE.

4. A nurse is teaching a community group of women about ways to decrease their risk of cardiovascular disease. What actions does the nurse recommend? (Select all that apply.) a. Stop smoking b. Drink 8 to 10 glasses of water daily c. Exercise on most days of the week d. Get your blood pressure checked e. Decrease the fat in your diet

ANS: A, C, D, E Risk factors for coronary artery disease include smoking, sedentary lifestyle, hypertension, and a high-fat diet. Drinking water is healthy but not specifically related to cardiovascular disease.

3. A woman reports a sudden gush of fluid from her vagina and is worried about premature rupture of her membranes. What other causes of this does the nurse assess for? (Select all that apply.) a. Urinary incontinence b. Leaking of amniotic fluid c. Loss of mucous plug d. An increase in vaginal discharge e. Bloody show

ANS: A, C, D, E Urinary incontinence, loss of the mucous plug (leading to bloody show), and increased vaginal discharge can all be mistaken for PROM. Leaking amniotic fluid is an indication of PROM.

2. Many women given up smoking during pregnancy to protect the health of the fetus. The majority of women resumed smoking within the first 6 months postpartum. Factors that increase the likelihood of relapse include (select all that apply) a. Living with a smoker b. Returning to work c. Weight concerns d. Successful breastfeeding e. Failure to breastfeed

ANS: A, C, E Feedback Correct Other factors include intending to quit for pregnancy only, depression, and stress. Incorrect Successful breastfeeding is likely to inhibit smoking. Returning to work, although stressful, does not necessarily increase a return to smoking.

4. The nursing faculty explains to students on the labor and delivery unit that late preterm and term births are very different. What distinguishes the late preterm birth from a term birth? (Select all that apply.) a. Late preterm births are between 34 and 36 completed weeks of pregnancy. b. There is no real difference in mortality between the two types of births. c. Late preterm infants may appear to be full term at delivery. d. A late preterm infant who appears full term is classified full term. e. Late preterm infants need careful assessments of gestational age.

ANS: A, C, E Late preterm and term deliveries are very different, with late preterm occurring between 34 and 36 completed weeks of gestation. Mortality for late preterm babies is three times higher than for term babies. Because infant appearance can be deceiving, very careful assessment are needed; the late preterm baby can appear as if he or she is full term.

1. The nurse is reviewing the educational packet provided to a patient about tubal ligation. What important facts should the nurse point out? (Select all that apply.) a. "It is highly unlikely that you will become pregnant after the procedure." b. "This is an effective form of 100% permanent sterilization." c. "Sterilization offers protection against sexually transmitted diseases." d. "Sterilization offers no protection against sexually transmitted diseases." e. "Your menstrual cycle will greatly increase after your sterilization."

ANS: A, D A woman is unlikely to get pregnant after a tubal ligation, but it is not impossible. Sterilization does not offer protection against STDs. Typically, the menstrual cycle remains the same after a tubal ligation.

3. The exact cause of breast cancer remains undetermined. Researchers have found that there are a number of common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors? (Select all that apply.) a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

ANS: A, D, E Family history, race, and nulliparity or first pregnancy after age 30 are all risk factors for breast cancer. Early menarche (not late) and late (not early) menopause are also risk factors.

19. During which stage of role attainment do the parents become acquainted with their baby and combine parenting activities with cues from the infant? a. Anticipatory b. Formal c. Informal d. Personal

ANS: B A The anticipatory stage begins during the pregnancy when the parents choose a physician and attend childbirth classes. B A major task of the formal stage of role attainment is getting acquainted with the infant. C The informal stage begins once the parents have learned appropriate responses to their infant's cues. D The personal stage is attained when parents feel a sense of harmony in their role.

18. The postpartum woman who continually repeats the story of her labor, delivery, and recovery experiences is a. Providing others with her knowledge of events b. Making the birth experience "real" c. Taking hold of the events leading to her labor and delivery d. Accepting her response to labor and delivery

ANS: B A This is to satisfy her needs, not others. B Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual. C She is in the taking-in phase, trying to make the birth experience seem real. D She is trying to make the event real and is trying to separate the infant from herself.

26. To promote bonding and attachment immediately after delivery, the nurse should a. Allow the mother quiet time with her infant. b. Assist the mother in assuming an en face position with her newborn. c. Teach the mother about the concepts of bonding and attachment. d. Assist the mother in feeding her baby.

ANS: B A The mother should be given as much privacy as possible; however, nursing assessments must still be continued during this critical time. B Assisting the mother in assuming an en face position with her newborn will support the bonding process. C The mother has just delivered and is more focused on the infant; she will not be receptive to teaching at this time. D This is a good time to initiate breastfeeding, but first the mother needs time to explore the new infant and begin the bonding process.

25. A man calls the nurse's station stating that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, "She was never like this before the baby was born." The nurse's initial response should be to a. Tell him to ignore the mood swings, as they will go away. b. Reassure him that this behavior is normal. c. Advise him to get immediate psychological help for her. d. Instruct him in the signs, symptoms, and duration of postpartum blues.

ANS: B A This blocks communication and may belittle the husband's concerns. B Before providing further instructions, inform family members of the fact that postpartum blues are a normal process to allay anxieties and increase receptiveness to learning. C Postpartum blues are a normal process that is short lived; no medical intervention is needed. D Client teaching is important; however, his anxieties need to be allayed before he will be receptive to teaching.

23. Infants in whom cephalhematomas develop are at increased risk for a. Infection b. Jaundice c. Caput succedaneum d. Erythema toxicum

ANS: B Feedback A Cephalhematomas do not increase the risk for infections. B Cephalhematomas are characterized by bleeding between the bone and its covering, the periosteum. Because of the breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. C Caput is an edematous area on the head from pressure against the cervix. D Erythema toxicum is a benign rash of unknown cause that consists of blotchy red areas.

36. By knowing about variations in infants' blood count, nurses can explain to their patients that a. A somewhat lower than expected red blood cell count could be the result of delay in clamping the umbilical cord. b. The early high white blood cell count (WBC) is normal at birth and should decrease rapidly. c. Platelet counts are higher than in adults for a few months. d. Even a modest vitamin K deficiency means a problem with the blood's ability to clot properly.

ANS: B Feedback A Delayed clamping of the cord results in an increase in hemoglobin and the red blood cell count. B The WBC is high the first day of birth and then declines rapidly. C The platelet count essentially is the same for newborns and adults. D Clotting is sufficient to prevent hemorrhage unless the vitamin K deficiency is significant.

21. The nurse should explain to new parents that the most serious consequence of propping an infant's bottle is a. Dental caries b. Aspiration c. Ear infections d. Colic

ANS: B Feedback A Dental caries become a problem when milk stays on the gums for a long period of time. This may cause a buildup of bacteria that will alter the growing teeth buds. However, this is not the most serious consequence. B Propping the bottle increases the likelihood of choking and aspiration if regurgitation occurs. C Ear infections can occur when the warm formula runs into the ear and bacterial growth occurs. However, this is not the most serious consequence. D Colic can occur, but it is not the most serious consequence.

34. The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them a. "Infants can see very little until about 3 months of age." b. "Infants can track their parent's eyes and can distinguish patterns; they prefer complex patterns." c. "The infant's eyes must be protected. Infants enjoy looking at brightly colored stripes." d. "It's important to shield the newborn's eyes. Overhead lights help them see better."

ANS: B Feedback A Development of the visual system continues for the first 6 months of life. Visual acuity is difficult to determine, but the clearest visual distance for the newborn appears to be 19 cm. B This is an accurate statement. C Infants prefer to look at complex patterns, regardless of the color. D Infants prefer low illumination and withdraw from bright light.

7. The hormone necessary for milk production is a. Estrogen b. Prolactin c. Progesterone d. Lactogen

ANS: B Feedback A Estrogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced. B Prolactin, secreted by the anterior pituitary, is a hormone that causes the breasts to produce milk. C Progesterone decreases the effectiveness of prolactin and prevents mature breast milk from being produced. D Human placental lactogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

25. Plantar creases should be evaluated within a few hours of birth because a. The newborn has to be footprinted. b. As the skin dries, the creases will become more prominent. c. Heel sticks may be required. d. Creases will be less prominent after 24 hours.

ANS: B Feedback A Footprinting will not interfere with the creases. B As the infant's skin begins to dry, the creases will appear more prominent, and the infant's gestation could be misinterpreted. C Heel sticks will not interfere with the creases. D The creases will appear more prominent after 24 hours.

16. To assess fundal contraction 6 hours after cesarean delivery, the nurse should a. Palpate forcefully through the abdominal dressing. b. Gently palpate, applying the same technique used for vaginal deliveries. c. Place hands on both sides of the abdomen and press downward. d. Rely on assessment of lochial flow rather than palpating the fundus.

ANS: B Feedback A Forceful palpation should never be used. B Assessment of the fundus is the same for both vaginal and cesarean deliveries; however, palpation should be gentle due to increased discomfort caused by the uterine incision. C The top of the fundus, not the sides, should be palpated and massaged. D The fundus should be palpated and massaged to prevent bleeding.

7. To prevent the kidnapping of newborns from the hospital, the nurse should a. Instruct the mother not to give her infant to anyone except the one nurse assigned to her that day. b. Question anyone who is seen walking in the hallways carrying an infant. c. Allow no visitors in the maternity area except those who have identification bracelets. d. Restrict the amount of time infants are out of the nursery.

ANS: B Feedback A It is impossible for one nurse to be on call for one mother and baby for the entire shift, so the parents need to be able to identify the nurses who are working on the unit. B Infants should be transported in the hallways only in their cribs. C This will be difficult to monitor and will limit the mother's support system from visiting. D Infants need to spend time with the parents to facilitate the bonding process.

2. When teaching parents about their newborn's transition to extrauterine life, the nurse explains which organs are nonfunctional during fetal life. They are the a. Kidneys and adrenals b. Lungs and liver c. Eyes and ears d. Gastrointestinal system

ANS: B Feedback A Kidneys and adrenals function during fetal life. The fetus continuously swallows amniotic fluid, which is filtered through the kidneys. B Most of the fetal blood flow bypasses the nonfunctional lungs and liver. C Near term, the eyes are open and the fetus can hear. D The gastrointestinal system functions during fetal life.

13. An unfortunate but essential role of the nurse is protecting the infant from abduction. Which statement regarding the profile of a potential abductor is the most accurate? a. Male gender b. A young woman who has had a previous pregnancy loss c. A middle-aged woman past childbearing age d. A female with a number of children of her own

ANS: B Feedback A Newborns are usually abducted by women who are familiar with the birth facility and its routines. B The woman is usually of childbearing age and may have had a previous pregnancy loss or has been unable to have a child of her own. She may want an infant to solidify the relationship with her husband or boyfriend and may have pretended to be pregnant. C Infant abductors are women of childbearing age, often overweight, who may live near the birth facility. D A woman who already has children of her own does not fit the profile of a potential abductor.

5. The nurse's initial action when caring for an infant with a slightly decreased temperature is to a. Notify the physician immediately. b. Place a cap on the infant's head and have the mother perform kangaroo care. c. Tell the mother that the infant must be kept in the nursery and observed for the next 4 hours. d. Change the formula, as this is a sign of formula intolerance.

ANS: B Feedback A Nursing actions are needed first to correct the problem. If the problem persists after interventions, notification may then be necessary. B A cap will prevent further heat loss from the head, and having the mother place the infant skin-to-skin should increase the infant's temperature. C A slightly decreased temperature can be treated in the mother's room. This would be an excellent time for parent teaching on prevention of cold stress. D Mild temperature instability is an expected deviation from normal during the first days as the infant adapts to external life.

9. If the fundus is palpated on the right side of the abdomen above the expected level, the nurse should suspect that the patient has a. Been lying on her right side too long b. A distended bladder c. Stretched ligaments that are unable to support the uterus d. A normal involution

ANS: B Feedback A Position of the patient should not alter uterine position. B The presence of a full bladder will displace the uterus. C The problem is a full bladder displacing the uterus. D This is not an expected finding.

21. The hips of a newborn are examined for developmental dysplasia. Which sign indicates an incomplete development of the acetabulum? a. Negative Ortolani's sign b. Thigh and gluteal creases are asymmetric c. Negative Barlow test d. Knee heights are equal

ANS: B Feedback A Positive Ortolani's sign yields a "clunking" sensation and indicates a dislocated femoral head moving into the acetabulum. B Asymmetric thigh and gluteal creases may indicate potential dislocation of the hip. C During a positive Barlow test, the examiner can feel the femoral head move out of acetabulum. D If the hip is dislocated, the knee on the affected side will be lower.

2. A new father wants to know what medication was put into his infant's eyes and why it is needed. The nurse explains to the father that the purpose of the Ilotycin ophthalmic ointment is to a. Destroy an infectious exudate caused by Staphylococcus that could make the infant blind. b. Prevent gonorrheal and chlamydial infection of the infant's eyes potentially acquired from the birth canal. c. Prevent potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to dry eyes. d. Prevent the infant's eyelids from sticking together and help the infant see.

ANS: B Feedback A Prophylactic ophthalmic ointment is instilled in the eyes of all neonates to prevent gonorrheal or chlamydial infection. B This is an accurate explanation. C Prophylactic ophthalmic ointment is not instilled to prevent dry eyes. It is instilled to prevent gonorrheal or chlamydial infection. D Prophylactic ophthalmic ointment has no bearing on vision other than to protect against infection that may lead to vision problems.

14. When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is a. Rectal suppositories b. Early and frequent ambulation c. Tightening and relaxing abdominal muscles d. Carbonated beverages

ANS: B Feedback A Rectal suppositories can be helpful after distention occurs, but do not prevent it. B Activity can aid the movement of accumulated gas in the gastrointestinal tract. C Ambulation is the best prevention. D Carbonated beverages may increase distention.

18. In order to prevent nipple trauma, the nurse should teach the new mother to a. Limit the feeding time to less than 5 minutes. b. Position the infant so the nipple is far back in the mouth. c. Assess the nipples before each feeding. d. Wash the nipples daily with mild soap and water.

ANS: B Feedback A Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. B If the infant's mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, causing trauma to the area. C Assessing the nipples for trauma is important, but it will not prevent sore nipples. D Soap can be drying to the nipples and should be avoided during breastfeeding.

24. What information about iron supplementation should the nurse teach a new mother? a. Start iron supplementation shortly after birth if the infant is breastfeeding exclusively. b. Iron-fortified formula will meet the infant's iron requirements. c. Iron supplements must be given when the infant begins teething. d. Infants need a multivitamin with iron every day.

ANS: B Feedback A Term infants who are exclusively breastfed have adequate iron stored until they are age 6 months. B Iron-fortified formula will meet the infant's initial iron requirements. Solid foods added to the diet maintain iron needs as formula intake decreases. C Iron supplements are not necessary for adequate teething. D Vitamins and minerals are added to processed formulas and cereals. It should not be necessary for the child to receive a multivitamin with iron unless the infant is at risk for undernutrition.

1. The breastfeeding mother should be taught a safe method to remove the breast from the baby's mouth. Which suggestion by the nurse is most appropriate? a. Slowly remove the breast from the baby's mouth when the infant has fallen asleep and the jaws are relaxed. b. Break the suction by inserting your finger into the corner of the infant's mouth. c. A popping sound occurs when the breast is correctly removed from the infant's mouth. d. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

ANS: B Feedback A The infant who is sleeping may lose grasp on the nipple and areola, resulting in "chewing" on the nipple, making it sore. B Inserting a finger into the corner of the baby's mouth between the gums to break the suction avoids trauma to the breast. C A popping sound indicates improper removal of the breast from the baby's mouth and may cause cracks or fissures in the breast. D Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.

15. A new mother is concerned because her 1-day-old newborn is taking only 1 ounce at each feeding. The nurse should explain that the a. Infant does not require as much formula in the first few days of life. b. Infant's stomach capacity is small at birth but will expand within a few days. c. Infant tires easily during the first few days but will gradually take more formula. d. Infant is probably having difficulty adjusting to the formula.

ANS: B Feedback A The infant's requirements are the same, but the stomach capacity needs to increase before taking in adequate amounts. B The infant's stomach capacity at birth is 10 to 20 mL and increases to 60 to 90 mL by the end of the first week. C The infant's sleep patterns do change, but the infant should be awake enough to feed. D There are other symptoms that occur if there is a formula intolerance.

8. Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of a. Increased pressure in the right atrium b. Increased pressure in the left atrium c. Decreased blood flow to the left ventricle d. Changes in the hepatic blood flow

ANS: B Feedback A The pressure in the right atrium decreases at birth. It is higher during fetal life. B With the increase in the blood flow to the left atrium from the lungs, the pressure is increased, and the foramen ovale is functionally closed. C Blood flow increases to the left ventricle after birth. D The hepatic blood flow changes, but that is not the reason for the closure of the foramen ovale.

3. A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the a. Transition period b. First period of reactivity c. Organizational stage d. Second period of reactivity

ANS: B Feedback A The transition period is the phase between intrauterine and extrauterine existence. B The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase. C There is no such phase as the organizational stage. D The second period of reactivity occurs roughly between 4 and 8 hours after birth, after a period of prolonged sleep.

6. How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day? a. 50 to 75 b. 85 to 100 c. 100 to 110 d. 150 to 200

ANS: B Feedback A This amount is too little and does not provide adequate nutrition. B The term breastfed infant requires 85 to 100 kcal/kg per day. C The term newborn requires 100 to 110 kcal/kg to meet nutritional needs each day. D This amount may be too large and would lead to overfeeding.

27. A new mother asks, "Why are you doing a gestational age assessment on my baby?" The nurse's best response is a. "This must be done to meet insurance requirements." b. "It helps us identify infants who are at risk for any problems." c. "The gestational age determines how long the infant will be hospitalized." d. "It was ordered by your doctor."

ANS: B Feedback A This is not accurate information. B The nurse should provide the mother with accurate information about various procedures performed on the newborn. C Gestational age does not dictate hospital stays. Problems that occur due to gestational age may prolong the stay. D Assessing gestational age is a nursing assessment and does not have to be ordered.

16. The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known as a. Enterohepatic circuit b. Conjugation of bilirubin c. Unconjugation of bilirubin d. Albumin binding

ANS: B Feedback A This is the route by which part of the bile produced by the liver enters the intestine, is reabsorbed by the liver, and then is recycled into the intestine. B Conjugation of bilirubin is the process of changing the bilirubin from a fat-soluble to a water-soluble product. C Unconjugated bilirubin is fat soluble. D Albumin binding is to attach something to a protein molecule.

12. To prevent breast engorgement, the new breastfeeding mother should be instructed to a. Apply cold packs to the breast before feeding. b. Breastfeed frequently and for adequate lengths of time. c. Limit her intake of fluids for the first few days. d. Feed her infant no more than every 4 hours.

ANS: B Feedback A Warm packs should be applied to the breast before feedings. B Engorgement occurs when the breasts are not adequately emptied at each feeding or if feedings are not frequent enough. C Fluid intake should not be limited with a breastfeeding mother; that will decrease the amount of breast milk produced. D Breast milk moves through the stomach within 1.5 to 2 hours, so waiting 4 hours to feed is too long. Frequent feedings are important to empty the breast and to establish lactation.

4. A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. Based on this information, this woman should feed her infant about every 2.5 to 3 hours when she a. Waves her arms in the air b. Makes sucking motions c. Has hiccups d. Stretches out her legs straight

ANS: B Feedback A Waving about her arms in the air is not a feeding readiness cue. B Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding-readiness cues. C Hiccups are not a typical feeding-readiness cue. D Stretching out her extremities is not a typical feeding-readiness cue.

A woman is in the emergency department with severe abdominal pain. When her pregnancy test comes back positive, she yells "I can't be pregnant! I had a tubal ligation two months ago!" What action by the nurse is the priority? a. Provide emotional support to the woman. b. Facilitate an ultrasound examination. c. Call the lab to have them repeat the test. d. Administer an opioid pain medication.

ANS: B A failed tubal ligation is a risk factor for ectopic pregnancy. After a blood pregnancy test, a transvaginal ultrasound is needed to look for a gestational sac within the uterus. Of course the nurse provides emotional support, but that is not the priority. There is no need to repeat the test. Pain medications may be contraindicated if surgery is needed and consents have not yet been signed.

31. The nurse should be aware that a pessary is most effective in the treatment of what disorder? a. Cystocele b. Uterine prolapse c. Rectocele d. Stress urinary incontinence

ANS: B A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. It is not used for cystocele, rectocele, or incontinence.

21. A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action? a. Provide a low-protein diet. b. Offer the vaccine. c. Discuss the recommendation to bottle-feed her baby. d. Practice respiratory isolation.

ANS: B A person who has a history of high-risk behaviors should be offered the hepatitis B vaccine. A low-protein diet will not prevent the infection. The first trimester is too early to discuss feeding methods. Respiratory isolation is not needed for this blood- and body fluid-borne disease.

33. A woman calls the triage nurse at the family medicine clinic and reports a raised area on her vulva. What response by the nurse is best? a. Ask her when her next annual physical is due. b. Make an appointment for the next day or two. c. Send her directly to the emergency department. d. Ask about protection she uses during sexual activity.

ANS: B A raised or discolored lesion of the vulva needs to be examined as soon as possible. The nurse should schedule the woman for the soonest available appointment. This could be a cancerous lesion and so should not wait until the next annual physical, so there is no reason to ask that question. While urgent, this is not something the woman should go to the ED for. The lesion is not related to STDs so asking about protection during sex is not needed.

8. A postpartum patient is at increased risk for postpartum hemorrhage if she delivers a(n) a. 5-lb, 2-oz infant with outlet forceps. b. 6.5-lb infant after a 2-hour labor. c. 7-lb infant after an 8-hour labor. d. 8-lb infant after a 12-hour labor.

ANS: B A rapid (precipitous) labor and delivery may cause exhaustion of the uterine muscle and prevent contraction. The use of forceps may cause lacerations that could lead to bleeding, but that is not as common as hemorrhage after a precipitous labor when they are used only in the outlet. Eight-hour and 12-hour labors are normal in length.

16. The nurse understands that postpartum care of the woman with cardiac disease a. is the same as that for any pregnant woman. b. includes rest and monitoring of the effect of activity. c. includes ambulating frequently, alternating with active range of motion. d. includes limiting visits with the infant to once per day.

ANS: B After delivery, the woman with cardiac disease should rest, and the nurse monitors her for the effect activity has on her cardiovascular status. Care of the woman with cardiac disease in the postpartum period is tailored to the woman's functional capacity. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.

A woman who is 8 months pregnant is brought to the emergency department after a serious motor vehicle crash. Although she has no apparent injuries, she is admitted to the hospital. Her partner is upset and wants to know why she just can't come home. What response by the nurse is best? a. "This is standard procedure for all pregnant crash victims." b. "She needs to be monitored for some potential complications." c. "We may have to deliver the baby at any time now." d. "We are giving her medicine to keep her from laboring."

ANS: B After serious trauma, a woman may be admitted and observed because an abruptio placentae may take up to 24 hours to become apparent. Not all motor vehicle crash patients will need to be admitted. The baby may or may not need to be delivered at any time, but this statement will frighten the partner. There is no indication the patient is in labor.

4. A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000-g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remains difficult to find, and the rubra lochia remains heavy. What action should the nurse take next? a. Continue to massage the fundus. b. Notify the provider. c. Recheck vital signs. d. Insert an indwelling urinary catheter.

ANS: B After taking these corrective actions, the nurse should contact the provider and anticipate collaborative care measures. Another nurse can assess vital signs. Since the woman just voided, an indwelling catheter is not needed.

22. If the nurse suspects a uterine infection in the postpartum patient, she should assess the a. pulse and blood pressure. b. odor of the lochia. c. episiotomy site. d. abdomen for distention.

ANS: B An abnormal odor of the lochia indicates infection in the uterus. The pulse may be altered with an infection, but the odor of the lochia will be an earlier sign and more specific. The infection may move to the episiotomy site if proper hygiene is not followed, but this does not demonstrate a uterine infection. The abdomen becomes distended usually because of a decrease of peristalsis, such as after cesarean section.

9. What instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications? a. Palpate the fundus daily to ensure that it is soft. b. Notify the physician of a return to bright red bleeding. c. Report any decrease in the amount of brownish red lochia. d. The passage of clots as large as an orange can be expected.

ANS: B An increase in lochia or a return to bright red bleeding after the lochia has become pink indicates a complication. The fundus should stay firm. Large clots after discharge are a sign of complications and should be reported.

A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. tocolytic. b. anticonvulsant. c. antihypertensive. d. diuretic.

ANS: B Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. A tocolytic drug does slow the frequency and intensity of uterine contractions, but it is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. Diuresis is a therapeutic response to magnesium sulfate

11. Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin a. increases throughout pregnancy and the postpartum period. b. decreases throughout pregnancy and the postpartum period. c. varies depending on the stage of gestation. d. should not change because the fetus produces its own insulin.

ANS: C Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells.

5. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurse's most appropriate response is a. "This is a highly effective method, but it has some side effects." b. "Your current medications will reduce the effectiveness of the pill." c. "The pill will reduce the effectiveness of your seizure medication." d. "This is a good choice for a woman of your age and personal history."

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants. Telling the woman the pill has some side effects or that it is a good choice for some women is not tailoring teaching to her specific situation. The anticonvulsant will reduce the effectiveness of the pill, not the other way around.

The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells. Any contraceptive method except an IUD is acceptable.

Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Positive KB test b. Presence of fibrin split products c. Thrombocytopenia d. Positive drug screen

ANS: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. The other lab tests are not indicative of DIC.

11. Why is adequate hydration important when uterine activity occurs before pregnancy is at term? a. Fluid and electrolyte imbalance can interfere with the activity of the uterine pacemakers. b. Dehydration may contribute to uterine irritability for some women. c. Dehydration decreases circulating blood volume, which leads to uterine ischemia. d. Fluid needs are increased because of increased metabolic activity occurring during contractions.

ANS: B Dehydration can contribute to uterine irritability for some women, especially if the woman has an infection. Fluid and electrolyte imbalances are not associated with preterm labor. The woman has an increased blood volume during pregnancy. Fluid needs do not increase due to contractions.

14. A young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse's most appropriate response is a. "The IUD does not interfere with sex." b. "The risk of pelvic inflammatory disease will be higher for you." c. "The IUD will protect you from sexually transmitted diseases." d. "Pregnancy rates are high with the IUDs."

ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted diseases (STDs) or the human immunodeficiency virus (HIV). Because this woman has multiple sex partners, she is at higher risk of developing an STD. The IUD does not protect against infection, as does a barrier method. Although the IUD does not interfere with sex, this is not the most appropriate response. The typical failure rate of the IUD ranges from 0.8% to 2%.

28. During her annual gynecologic checkup, a woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse should document this complaint as a. amenorrhea. b. dysmenorrhea. c. dyspareunia. d. PMS.

ANS: B Dysmenorrhea is pain during or shortly before menstruation. Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.

4. A couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurse's most appropriate reply is a. "They're not very effective, and it's very likely you'll get pregnant." b. "They can be effective for many couples, but they require motivation." c. "These methods have a few advantages and several health risks." d. "You would be much safer going on the pill and not having to worry."

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. However, the typical failure rate is 25%. This is not the best response, however. The nurse should provide positive feedback first; otherwise, the couple may become discouraged and think the nurse is negative or biased against a method they are interested in. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the patient's part.

21. With regard to the assessment of female, male, and couple infertility, nurses should be aware of which of the following? a. The couple's religious, cultural, and ethnic backgrounds do not affect the diagnosis. b. The investigation is lengthy and can be very costly. c. The woman is assessed first; if she is not the problem, the male partner is analyzed. d. Semen analysis is for men; the postcoital test is for women.

ANS: B Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an impact on diagnosis and assessment. Both partners are assessed systematically and simultaneously, as individuals and as a couple. Semen analysis is for men, but the postcoital test is for the couple.

24. An hour after her membranes ruptured, a laboring woman has a temperature of 38.2° C (100.7° F). What action does the nurse perform first? a. Provide cool, wet washcloths for the woman's forehead. b. Assess and document the fetal heart rate. c. Administer acetaminophen orally. d. Encourage the woman to drink clear fluids.

ANS: B Fetal tachycardia is associated with maternal fever. While all options are reasonable, the nurse needs to assess fetal well-being first.

6. A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? a. Call for help. b. Assess the fundus for firmness. c. Take her blood pressure. d. Check the perineum for lacerations.

ANS: B Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated. Calling for help is not needed unless corrective action does not improve the situation. Another nurse can take the blood pressure or the original nurse can do so after assessing the fundus and massaging it if needed. Checking the perineum for lacerations would be appropriate if the fundus was firm.

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Anxiety due to hospitalization b. Worsening disease and impending seizure c. Effects of magnesium sulfate d. Gastrointestinal upset

ANS: B Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a seizure is imminent. These sign are not due to anxiety or magnesium sulfate or related to gastrointestinal upset.

10. In helping a patient manage PMS, the nurse should a. recommend a diet with more red meat and sugar. b. suggest herbal therapies and massage. c. tell the patient to ask for medications as soon as symptoms occur. d. suggest the use of diuretics.

ANS: B Herbal therapies, conscious relaxation and massage have all been reported to have a beneficial effect on PMS. Carbohydrates may decrease cravings. Medications can be tried if lifestyle changes do not help or if there are depressive symptoms. Diuretics are not usually prescribed.

3. The nurse knows that a measure for preventing late postpartum hemorrhage is to a. administer broad-spectrum antibiotics. b. inspect the placenta after delivery. c. manually remove the placenta. d. pull on the umbilical cord to hasten the delivery of the placenta.

ANS: B If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage. Broad-spectrum antibiotics will be given if postpartum infection is suspected. Manual removal of the placenta increases the risk of postpartum hemorrhage. The placenta is usually delivered 5 to 30 minutes after birth of the baby without pulling on the cord. That can cause uterine inversion.

17. The physician diagnoses a 3-cm ovarian cyst in a 28-year-old woman. The nurse expects the initial treatment to include a. beginning hormone therapy. b. examining the woman after her next menstrual period. c. scheduling a laparoscopy as soon as possible, to remove the cyst. d. aspirating the cyst as soon as possible and sending the fluid to pathology.

ANS: B If the woman is in her childbearing years, when the risk of ovarian cancer is less, the physician may wait until after the next menstrual cycle and examine the woman again. Cysts in women of childbearing age may decrease within one cycle, so treatment is not necessary at this point.

Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. In a partial abruptio placentae, if the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

What data on a patient's health history places her at risk for an ectopic pregnancy? a. Use of oral contraceptives for 5 years b. Recurrent pelvic infections c. Ovarian cyst 2 years ago d. Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. Oral contraceptives, ovarian cysts, and heavy menstrual flows do not increase risk.

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. an antiemetic, such as pyridoxine, to control nausea and vomiting. d. enteral nutrition to correct nutritional deficits.

ANS: B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids are not the expected treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

18. The patient who is being treated for endometritis is placed in Fowler's position because it a. promotes comfort and rest. b. facilitates drainage of lochia. c. prevents spread of infection to the urinary tract. d. decreases tension on the reproductive organs.

ANS: B Lochia and infectious material are eliminated by gravity drainage when the woman is placed in the Fowler's position.

12. A 49-year-old patient confides to the nurse that she has started experiencing pain with intercourse and asks, "Is there anything I can do about this?" What is the best response by the nurse? a. "You need to be evaluated for a sexually transmitted disease." b. "Water-soluble vaginal lubricants may provide relief." c. "No, it is part of the aging process." d. "You may have vaginal scar tissue that is producing the discomfort."

ANS: B Loss of lubrication with resulting discomfort in intercourse is a symptom of estrogen deficiency. This is a normal occurrence with the aging process and does not indicate STDs. It is part of the aging process, but the use of lubrication will help relieve the symptoms. It is due to loss of lubrication with the decrease in estrogen and not scar tissue formation.

10. Which woman is at greatest risk for early postpartum hemorrhage? a. A primiparous woman being prepared for an emergency cesarean birth for fetal distress b. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced c. A multiparous woman with an 8-hour labor d. A primigravida in spontaneous labor with preterm twins

ANS: B Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. The other situations do not post risk factors or causes of early PPH.

29. A provider left an order for a woman to have Methylergonovine 0.2 mg IM. The nurse assesses the woman and finds her vital signs to be: temperature 37.9° C (100.2° F), pulse 90 beats/minute, respirations 18 breaths/minute, and blood pressure 152/90 mm Hg. What action by the nurse is most appropriate? a. Administer acetaminophen first. b. Check policy for administration. c. Give the medication as prescribed. d. Consult with the provider.

ANS: B Methylergonovine is contraindicated in women with hypertension. The nurse should check the agency's policy to see at what blood pressure reading this medication should be held. After checking the policy, the nurse can consult the provider if it can't be given. Acetaminophen is not related to this situation.

An abortion in which the fetus dies but is retained in the uterus is called ________ abortion. a. inevitable b. missed c. incomplete d. threatened

ANS: B Missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

1. Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with a. frequent episodes of maternal hypoglycemia. b. congenital anomalies in the fetus. c. polyhydramnios. d. hyperemesis gravidarum.

ANS: B Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events as the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

15. Which nursing measure is appropriate to prevent thrombophlebitis in the recovery period after a cesarean birth? a. Roll a bath blanket and place it firmly behind the knees. b. Limit oral intake of fluids for the first 24 hours. c. Assist the patient in performing gentle leg exercises. d. Ambulate the patient as soon as her vital signs are stable.

ANS: C Leg exercises and passive range of motion promote venous blood flow and prevent venous stasis while the patient is still on bed rest. The blanket behind the knees will cause pressure and decrease venous blood flow. Limiting oral intake will produce hemoconcentration, which may lead to thrombophlebitis. The patient may not have full return of leg movements, and ambulating is contraindicated until she has full motion and sensation.

19. For which of the infectious diseases can a woman be immunized? a. Toxoplasmosis b. Rubella c. Cytomegalovirus d. Herpesvirus type 2

ANS: B Rubella is the only infectious disease listed for which a vaccine is available.

14. The mother-baby nurse must be able to recognize what sign of thrombophlebitis? a. Visible varicose veins b. Positive Homans sign c. Local tenderness, heat, and swelling d. Pedal edema in the affected leg

ANS: C Tenderness, heat, and swelling are classic signs of thrombophlebitis that appear at the site of the inflammation. Varicose veins may predispose the woman to thrombophlebitis but are not a sign. A positive Homans sign may be caused by a strained muscle or contusion. Edema may be caused by other factors, and the edema with thrombophlebitis may be more extensive. Edema may be more involved than pedal.

2. The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called a. bimanual palpation. b. rectovaginal palpation. c. a Papanicolaou test. d. DNA testing.

ANS: C The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the patient's age. Bimanual palpation is a physical examination of the vagina,. rectovaginal palpation is a physical examination performed through the rectum, and DNA testing for the various types of HPV that cause cervical cancer is now available. Samples are collected in the same way as a Pap test.

11. Which contraceptive method is contraindicated in a woman with a history of toxic shock syndrome? a. Condom b. Spermicide c. Cervical cap d. Norplant

ANS: C The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. Condoms, spermicides, and Norplant are not contraindicated in women who have had toxic shock syndrome.

24. A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this patient, the nurse should know that a. fibroids are malignant tumors of the uterus. b. fibroids will increase in size during the perimenopausal period. c. abnormal uterine bleeding is a common finding. d. hysterectomy should be performed.

ANS: C The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large leimyomas. Excessive menstrual bleeding is one possible symptom of fibroids. They are benign. They atrophy during menopause. A hysterectomy may be performed if the woman does not want more children and other therapies are not successful. Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown. Fibroids are estrogen-sensitive and shrink as levels of estrogen decline.

21. A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that a. the infant is protected from infection by immunoglobulins in the breast milk. b. the infant is not susceptible to the organisms that cause mastitis. c. the organisms that cause mastitis are not passed to the milk. d. the organisms will be inactivated by gastric acid.

ANS: C The organisms are localized in the breast tissue and are not excreted in the breast milk. The mother is just producing the immunoglobulin from this infection, so it is not available for the infant. Because of an immature immune system, infants are susceptible to many infections. However, this infection is in the breast tissue and is not excreted in the breast milk. The organism will not get into the infant's gastrointestinal system.

What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Many women have nausea in the first trimester. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. The history of bleeding is normally described as being brownish.

18. A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed? a. Testicular biopsy b. Antisperm antibodies c. FSH level d. Examination for testicular infection

ANS: C The woman has irregular menstrual cycles. The scenario does not indicate that she has had any testing related to this irregularity. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles. A testicular biopsy would be indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Antisperm antibodies are produced by a man against his own sperm. This is unlikely to be the case here, because the husband has already produced children. Examination for testicular infection should be done before semen analysis. Furthermore, infection affects spermatogenesis. However, the woman's hormone levels would likely be tested first.

24. A woman who had no prenatal care has just delivered after a brief labor. The baby has rough, dry skin; is large for gestational age; and has an umbilical hernia. What action by the nurse is most appropriate? a. Question the mother about substance abuse. b. Reassess the baby's gestational age. c. Inform the mother her thyroid levels will be checked. d. Perform a bedside blood glucose test on the mother.

ANS: C These signs in the newborn are indicative of hypothyroidism. The mother will have thyroid levels checked. Asking about substance abuse, reassessing gestational age, and obtaining a blood glucose reading are all unnecessary.

23. A nurse is teaching a couple about basal body temperature. What information is most accurate? a. Measures the man's scrotal temperature related to sperm production. b. Basal body temperature is the average resting temperature in the woman. c. It detects slight temperature elevation just prior to ovulation in the woman d. Ovulation is the only event that affects the change in body temperature.

ANS: C This method assesses for the slight rise in temperature just prior to ovulation. It is done on the woman and not the man. Other factors such as illness and poor sleep can affect the reading.

The labor of a pregnant woman with preeclampsia is going to be induced. The nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. What action by the nurse is most important? a. Palpate the woman's abdomen for tenderness. b. Document findings and begin the Pitocin infusion. c. Instruct the woman to ask for help getting out of bed. d. Assess the woman's drinking history.

ANS: C This woman has HELLP syndrome, with is characterized by low platelet counts and hepatic dysfunction. She is at risk for bleeding, so the nurse instructs her to call for assistance in getting in and out of bed. The nurse does not palpate the abdomen even though the woman may complain of abdominal pain because of possible rupture of a subcapsular hematoma. The findings should be documented but the nurse should intervene based on the abnormal findings. The liver enzymes are not elevated because of alcohol intake.

24. When a woman is diagnosed with postpartum psychosis, one of the main concerns is that she may a. have outbursts of anger. b. neglect her hygiene. c. harm her infant. d. lose interest in her husband.

ANS: C Thoughts of harm to one's self or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. The other problems can be attributed to postpartum psychosis, but the major concern is harm to the infant.

15. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by a. limiting sexual contact for one cycle after starting the pill. b. using condoms and foam instead of the pill for as long as she takes an antibiotic. c. taking one pill at the same time every day. d. using a backup method if she misses two pills during week 1 of her cycle.

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, patients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or abortion, another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the patient misses two pills during week 1, she should take two pills a day for 2 days and finish the package and use a backup method for the next 7 consecutive days.

19. A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What response by the nurse is most appropriate? a. "Tell your friends and family so that they can help you." b. "Talk only to other friends who are infertile, because only they can help." c. "Get involved with a support group. I'll give you some names." d. "You might start thinking about adoption to end this roller coaster of emotion."

ANS: C Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others' experiences. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couple's relationships with family and friends who often don't understand the couple's feelings. It is not reasonable to suggest they only talk to other infertile couples. The nurse should not suggest the couple consider adoption while they are still trying to conceive, plus adoption has its own set of stressors.

23. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Core needle biopsy d. MRI

ANS: C When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core needle biopsy or one of the other types of biopsies. A mammogram screens for breast cancer. An ultrasound may be used with or before biopsy. An MRI might be used in select cases.

7. A woman is having her first child. She has been in labor for 15 hours. Two hours ago, her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago, her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? a. Prolonged latent phase b. Protracted active phase c. Secondary arrest d. Protracted descent

ANS: C With a secondary arrest of the active phase, the progress of labor has stopped. This patient has not had any anticipated cervical change, indicating an arrest of labor. Dilation at 5 cm is past the latent phase. This does not describe a "protracted" labor.

6. A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? a. She is exhibiting hypotonic uterine dysfunction. b. She is experiencing a normal latent stage. c. She is exhibiting hypertonic uterine dysfunction. d. She is experiencing pelvic dystocia.

ANS: C Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor and then the contractions become weak and inefficient or stop altogether. This is not a normal latent stage. Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.

17. In caring for a pregnant woman with sickle cell anemia the nurse is aware that signs and symptoms of sickle cell crisis include a. anemia. b. endometritis. c. fever and pain. d. urinary tract infection.

ANS: C Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia, or acidosis. Signs of crisis do not include anemia, endometriosis, or UTI.

4. When caring for a pregnant woman with suspected cardiomyopathy, the nurse must be alert for signs and symptoms of cardiac decompensation, which include (Select all that apply.) a. A regular heart rate b. Hypertension c. Shortness of breath d. Weakness e. Crackles in the lung bases

ANS: C, D, E Some symptoms of cardiomyopathy include shortness of breath, weakness, and crackles in the lung bases. A regular heart rate may or may not be present. Hypertension is not a typical finding.

24. A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your initial action should be to a. Assess her for pain. b. Point out how lucky she is to have a healthy baby. c. Explain that she is experiencing postpartum blues. d. Allow her time to express her feelings.

ANS: D A This is an assumption. There is no evidence that she is in pain. B This is blocking communication. C She needs the opportunity to express her feelings first. Later, patient teaching can occur. D Although many women experience transient postpartum blues, they need assistance in expressing their feelings. This condition affects 70-80% of new mothers.

10. A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders? a. The woman is a gravida 2, para 2. b. The woman had a vacuum-assisted birth. c. The woman received epidural anesthesia. d. The woman has an episiotomy.

ANS: D Feedback A A multiparous classification is not an indication for these orders. B A vacuum-assisted birth may be used in conjunction with an episiotomy, which indicates these interventions. C Use of epidural anesthesia has no correlation with these orders. D These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids.

31. The nurse caring for the postpartum woman understands that breast engorgement is caused by a. Overproduction of colostrum b. Accumulation of milk in the lactiferous ducts and glands c. Hyperplasia of mammary tissue d. Congestion of veins and lymphatics

ANS: D Feedback A Breast engorgement is not the result of overproduction of colostrum. B Accumulation of milk in the lactiferous ducts and glands does not cause breast engorgement. C Hyperplasia of mammary tissue does not cause breast engorgement. D Breast engorgement is caused by the temporary congestion of veins and lymphatics.

12. The infant with the lowest risk of developing high levels of bilirubin is the one who a. Was bruised during a difficult delivery b. Developed a cephalhematoma c. Uses brown fat to maintain temperature d. Breastfeeds during the first hour of life

ANS: D Feedback A Bruising will release more bilirubin into the system. B Cephalhematomas will release bilirubin into the system as the red blood cells die off. C Brown fat is normally used to produce heat in the newborn. D The infant who is fed early will be less likely to retain meconium and reabsorb bilirubin from the intestines back into the circulation.

4. In providing and teaching cord care, what is an important principle? a. Cord care is done only to control bleeding. b. Alcohol is the only agent used for cord care. c. It takes a minimum of 24 days for the cord to separate. d. The process of keeping the cord dry will decrease bacterial growth.

ANS: D Feedback A Cord care is to prevent infection and add in the drying of the cord. B No agents are necessary to facilitate drying of the cord. C The cord will fall off within 10 to 14 days. D Bacterial growth increases in a moist environment, so keeping the umbilical cord dry impedes bacterial growth.

29. A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse's most appropriate response is to ask the woman a. "Didn't you like your lunch?" b. "Does your doctor know that you are planning to eat that?" c. "What is that anyway?" d. "I'll warm the soup in the microwave for you."

ANS: D Feedback A Cultural dietary preferences must be respected. B Women may request that family members bring favorite or culturally appropriated foods to the hospital. C Cultural dietary preferences must be respected. A statement such as this does not show cultural sensitivity. D This statement shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response.

35. Childbirth may result in injuries to the vagina and uterus. Pelvic floor exercises also known as Kegel exercises will help to strengthen the perineal muscles and encourage healing. The nurse knows that the patient understands the correct process for completing these conditioning exercises when she reports a. "I contract my thighs, buttocks, and abdomen." b. "I do 10 of these exercises every day." c. "I stand while practicing this new exercise routine." d. "I pretend that I am trying to stop the flow of urine midstream."

ANS: D Feedback A Each contraction should be as intense as possible without contracting the abdomen, buttocks, or thighs. B Guidelines suggest that these exercises should be done 24 to 100 times per day. Positive results are shown with a minimum of 24 to 45 repetitions per day. C The best position to learn Kegel exercises is to lie supine with knees bent. A secondary position is on the hands and knees. D The woman can pretend that she is attempting to stop the passing of gas, or the flow of urine midstream. This will replicate the sensation of the muscles drawing upward and inward.

3. How can the nurse help the mother who is breastfeeding and has engorged breasts? a. Suggest that she switch to bottled formula just for today. b. Assist her into removing her bra, making her more comfortable. c. Apply heat to her breasts between feeding and cold to the breasts just before feedings. d. Instruct and assist the mother to massage her breasts.

ANS: D Feedback A Engorgement is more likely to increase if breastfeeding is delayed or infrequent. B A well-fitting bra should be worn both day and night to support the breasts. C Cold applications are used between feedings to reduce edema and pain. Heat is applied just before feedings to increase vasodilation. D Massage of the breasts causes release of oxytocin and increases the speed of milk release.

20. An important aspect about storage of breast milk is that it a. Can be frozen for up to 2 months b. Should be stored only in glass bottles c. Can be thawed and refrozen d. Can be kept refrigerated for 48 hours

ANS: D Feedback A Frozen milk should be kept for 1 month only. B Antibodies in the milk will adhere to glass bottles. Only rigid polypropylene plastic containers should be used. C It should not be refrozen. D If used within 48 hours after being refrigerated, breast milk will maintain its full nutritional value.

28. A new father states, "I know nothing about babies," but he seems to be interested in learning. The nurse should a. Continue to observe his interaction with the newborn. b. Tell him when he does something wrong. c. Show no concern, as he will learn on his own. d. Include him in teaching sessions.

ANS: D Feedback A It is important to note the bonding process of the mother and the father, but that does not satisfy the expressed needs of the father. B He should be encouraged by pointing out the correct procedures he does. Criticizing him will discourage him. C This is not a nursing role. Nurses need to be sensitive to patients' needs. D The nurse must be sensitive to the father's needs and include him whenever possible. As fathers take on care new role, the nurse should praise every attempt even if his early care is awkward.

31. An African-American woman noticed some bruises on her newborn girl's buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called a. Lanugo b. Vascular nevi c. Nevus flammeus d. Mongolian spots

ANS: D Feedback A Lanugo is the fine, downy hair seen on a term newborn. B A vascular nevus, commonly called a strawberry mark, is a type of capillary hemangioma. C A nevus flammeus, commonly called a port-wine stain, is most frequently found on the face. D A Mongolian spot is a bluish black area of pigmentation that may appear over any part of the exterior surface of the body. It is more commonly noted on the back and buttocks and most frequently is seen on infants whose ethnic origins are Mediterranean, Latin American, Asian, or African.

17. When responding to the question "Will I produce enough milk for my baby as she grows and needs more milk at each feeding?" the nurse should explain that a. The breast milk will gradually become richer to supply additional calories. b. As the infant requires more milk, feedings can be supplemented with cow's milk. c. Early addition of baby food will meet the infant's needs. d. The mother's milk supply will increase as the infant demands more at each feeding.

ANS: D Feedback A Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. B Supplementation will decrease the amount of stimulation of the breast and decrease the milk production. C Solids should not be added until about 4 to 6 months, when the infant's immune system is more mature. This will decrease the chance of allergy formations. D The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant.

27. All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital Initiative endorsed by WHO and Unicef was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which is not one of the "Ten Steps to Successful Breastfeeding for Hospitals"? a. Give newborns no food or drink other than breast milk. b. Have a written breastfeeding policy that is communicated to all staff. c. Help mothers initiate breastfeeding within one half hour of birth. d. Give artificial teats or pacifiers as necessary.

ANS: D Feedback A No other food or drink should be given to the newborn unless medically indicated. B The breastfeeding policy should be routinely communicated to all health care staff. All staff should be trained in the skills necessary to maintain this policy. C Breastfeeding should be initiated within one half hour of birth and all mothers need to be shown how to maintain lactation even if separated from their babies. D No artificial teats or pacifiers (also called dummies or soothers) should be given to breastfeeding infants.

13. Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus? a. Notify the physician of an impending hemorrhage. b. Assess the blood pressure and pulse. c. Evaluate the lochia. d. Assist the patient in emptying her bladder.

ANS: D Feedback A Nursing actions need to be implemented before notifying the physician. B This is an important assessment if the bleeding continues. However, the focus should be on controlling the bleeding. C The focus needs to be on controlling the bleeding. D Urinary retention can cause overdistention of the urinary bladder, which lifts and displaces the uterus.

30. Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse might try is a. Pouring water from a squeeze bottle over the woman's perineum b. Providing hot tea c. Asking the physician to prescribe analgesics d. Inserting a sterile catheter

ANS: D Feedback A Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried early on. B Hot tea or other fluids ad lib is an easy, noninvasive strategy, that should be tried early on. C If the woman is anticipating pain from voiding, pain medications may be helpful. Other nonmedical means could be tried first, but medications still come before insertion of a catheter. D Invasive procedures usually are the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills).

7. A postpartum patient asks, "Will these stretch marks go away?" The nurse's best response is a. "They will continue to fade and should be gone by your 6-week checkup." b. "No, never." c. "Yes, eventually." d. "They will fade to silvery lines but won't disappear completely."

ANS: D Feedback A Stretch marks do not disappear. B This is true, but more information can be added, such as the changes that will occur with the stretch marks. C This is not a true statement; they will not disappear. D Stretch marks never disappear altogether, but they gradually fade to silvery lines.

3. Which maternal event is abnormal in the early postpartum period? a. Diuresis and diaphoresis b. Flatulence and constipation c. Extreme hunger and thirst d. Lochial color changes from rubra to alba

ANS: D Feedback A The body rids itself of increased plasma volume. Urine output of 3000 mL/day is common for the first few days after delivery and is facilitated by hormonal changes in the mother. B Bowel tone remains sluggish for days. Many women anticipate pain during defecation and are unwilling to exert pressure on the perineum. C The new mother is hungry because of energy used in labor and thirsty because of fluid restrictions during labor. D For the first 3 days after childbirth, lochia is termed rubra. Lochia serosa follows, and then at about 11 days, the discharge becomes clear, colorless, or white.

10. A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. The nurse can facilitate the infant's correct latch-on by helping the woman hold the infant a. With his arms folded together over his chest b. Curled up in a fetal position c. With his head cupped in her hand d. With his head and body in alignment

ANS: D Feedback A The infant should be facing the mother with his arms hugging the breast. B The baby's body should be held in correct alignment (ears, shoulder, hips in a straight line) during feedings. C The mother should support the baby's neck and shoulders with her hand and not push on the occiput. D The infant's head and body should be in correct alignment with the mother and the breast during latch-on and feeding.

15. When the newborn infant is fed, the most likely cause of regurgitation is a. Placing the infant in a prone position after a feeding b. The gastrocolic reflex c. An underdeveloped pyloric sphincter d. A relaxed cardiac sphincter

ANS: D Feedback A The infant should be placed in a supine position. B The gastrocolic reflex increases intestinal peristalsis after the stomach fills. C The pyloric sphincter goes from the stomach to the intestines. D The underlying cause of newborn regurgitation is a relaxed cardiac sphincter.

12. If rubella vaccine is indicated for a postpartum patient, instructions to the patient should include a. Drinking plenty of fluids to prevent fever b. No specific instructions c. Recommending that she stop breastfeeding for 24 hours after injection d. Explaining the risks of becoming pregnant within 1 month after injection

ANS: D Feedback A The mother should be afebrile before the vaccine. B The mother does need to understand potential side effects, and that pregnancy is discouraged for at least 28 days after receiving the vaccine. C Small amounts of the vaccine do cross the breast milk, but it is believed that there is no need to discontinue breastfeeding. D Potential risks to the fetus can occur if pregnancy results within 28 days after rubella vaccine administration.

1. A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago via cesarean section is found to have moist lung sounds. What is the best interpretation of these data? a. The nurse should notify the pediatrician stat for this emergency situation. b. The neonate must have aspirated surfactant. c. If this baby was born vaginally, it could indicate a pneumothorax. d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

ANS: D Feedback A This is a common condition for infants delivered by cesarean section. B Surfactant is produced by the lungs, so aspiration is not a concern. C It is common to have some fluid left in the lungs; this will be absorbed within a few hours. D The condition will resolve itself within a few hours. For this common condition of newborns, surfactant acts to keep the expanded alveoli partially open between respirations. In vaginal births, absorption of remaining lung fluid is accelerated by the process of labor and delivery. Remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and lymphatic systems.

30. A sign of illness in the newborn is a. More than two soft stools per day b. Regurgitating a small amount of feeding c. A yellow scaly lesion on the scalp d. An axillary temperature greater than 37.5° C

ANS: D Feedback A This is an expected finding in the newborn. B This is an expected finding in the newborn. C This is a sign of cradle cap or seborrhea capitis. D Infants commonly respond to a variety of illnesses with an elevation in temperature. The normal range for an axillary temperature in the newborn is 36.5° to 37.3° C.

11. A postpartum woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who a. Sleeps for 6 hours at a time between feedings b. Has at least one breast milk stool every 24 hours c. Gains 1 to 2 ounces per week d. Has at least six to eight wet diapers per day

ANS: D Feedback A This is not an indication of whether the infant is breastfeeding well. Typically infants sleep 2 to 4 hours between feedings, depending on whether they are being fed on a 2- to 3-hour schedule or cluster-fed. B The infant should have a minimum of three bowel movements in a 24-hour period. C Breastfed infants typically gain 15 to 30 g/day. D After day 4, when the mother's milk comes in, the infant should have six to eight wet diapers every 24 hours.

6. When teaching parents about mandatory newborn screening, it is important for the nurse to explain that the main purpose is to a. Keep the state records updated. b. Allow accurate statistical information. c. Document the number of births. d. Recognize and treat newborn disorders early.

ANS: D Feedback A This is not the main reason for the screening test. B This is not the main reason for the screening test. C The number of births does not come from the newborn screening test. D Early treatment of disorders will prevent morbidity associated with inborn errors of metabolism or other genetic conditions.

18. The most likely interpretation of an elevated immunoglobulin M (IgM) level in a newborn is a. The infant was breastfed during the first hours after birth b. Transference of immune globulins from the placenta to the infant c. An overwhelming allergic response to an antigen d. A recent exposure to a pathogenic agent

ANS: D Feedback A This is the IgA. B This is the IgG. C This is not associated with elevated levels of IgM. D An elevated level of IgM is associated with exposure to infection in utero because IgM does not cross the placenta.

12. A nurse is responsible for teaching new parents about the hygienic care of their newborn. The nurse should tell the parents to a. Avoid washing the head for at least 1 week to prevent heat loss. b. Sponge bathe only until the cord has fallen off. c. Cleanse the ears and nose with cotton-tipped swabs, such as Q-tips. d. Water temperature should be at least 38° C.

ANS: D Feedback A To prevent heat loss, the infant's head should be bathed before unwrapping and undressing. B Tub baths may be initiated from birth. Ensure that the infant is fully immersed. C Q-tips should not be used, because they may cause injury. A corner of a moistened washcloth should be twisted into shape so that it can be used to cleanse the ears and nose. D The ideal temperature of the bath water should be at least 38° C or 100.4° F.

34. Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium? a. Varicosities of the legs b. Carpal tunnel syndrome c. Periodic numbness and tingling of the fingers d. Headaches

ANS: D Feedback A Total or nearly total regression of varicosities is expected after childbirth. However, headaches might deserve attention. B Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened. Headaches, however, might deserve attention. C Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition. Headaches, however, might deserve attention. D Headaches in the postpartum period can have a number of causes, some of which deserve medical attention.

13. The difference between the aseptic and terminal methods of sterilization is that the a. Aseptic method does not require boiling of the bottles. b. Terminal method requires boiling water to be added to the formula. c. Aseptic method requires a longer preparation time. d. Terminal method sterilizes the prepared formula at the same time it sterilizes the equipment.

ANS: D Feedback A With the aseptic method, the bottles are boiled separate from the formula. B With the terminal method, the formula is prepared, placed in bottles, and everything is boiled at one time. C The terminal method takes 25 minutes to boil; the aseptic method takes 5 minutes to boil. D In the terminal sterilization method, the formula is prepared in the bottles, which are loosely capped, and then the bottles are placed in the sterilizer, where they are boiled for 25 minutes.

21. A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old brother is punching his mother on the back. The nurse should a. Report the incident to the social services department. b. Advise the parents that the toddler needs to be reprimanded. c. Report to oncoming staff that the mother is probably not a good disciplinarian. d. Realize that this is a normal family adjusting to family change.

ANS: D A There is no need to report this one incident. B Giving advice at this point would make the parents feel inadequate as parents. C This is normal for an adjusting family. D The observed behaviors are normal variations of families adjusting to change.

A placenta previa in which the placental edge just reaches the internal os is called a. total. b. partial. c. complete. d. marginal.

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa the placenta completely covers the os. With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os

19. The fetus in a breech presentation is often born by cesarean delivery because a. the buttocks are much larger than the head. b. postpartum hemorrhage is more likely if the woman delivers vaginally. c. internal rotation cannot occur if the fetus is breech. d. compression of the umbilical cord is more likely.

ANS: D After the fetal legs and trunk emerge from the woman's vagina, the umbilical cord can be compressed between the maternal pelvis and the fetal head if a delay occurs in the birth of the head. The head is the largest part of a fetus. There is no relationship between breech presentation and postpartum hemorrhage. Internal rotation can occur with a breech.

1. Which actions by the nurse may prevent infections in the labor and delivery area? a. Vaginal examinations every hour while the woman is in active labor b. Use of clean techniques for all procedures c. Cleaning secretions from the vaginal area by using back-to-front motion d. Keeping underpads and linens as dry as possible

ANS: D Bacterial growth prefers a moist, warm environment. Vaginal examinations should be limited to decrease transmission of vaginal organisms into the uterine cavity. Use an aseptic technique if membranes are not ruptured; use a sterile technique if membranes are ruptured. Vaginal drainage should be removed with a front-to-back motion to decrease fecal contamination.

7. Which woman is the safest candidate for the use of oral contraceptives? a. 39-year-old with a history of thrombophlebitis b. 16-year-old with a benign liver tumor c. 20-year-old who suspects she may be pregnant d. 43-year-old who does not smoke cigarettes

ANS: D Cigarette smoking is a contraindication, especially in women older than 35. Oral contraceptives are contraindicated with a history of thrombophlebitis, liver tumors, or pregnancy.

13. If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. D&C

ANS: D D&C allows examination of the uterine contents and removal of any retained placental fragments or blood clots. Hysterectomy, laparoscopy, and laparotomy are not indicated.

In which situation is a dilation and curettage (D&C) indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. After that there is a greater risk of excessive bleeding, and this procedure may not be used. If all the products of conception have been passed (complete abortion), a D&C is not used. If the pregnancy is still viable (threatened abortion), a D&C is not used.

4. Which statement by a woman diagnosed with premenstrual syndrome indicates that further health teaching is needed? a. "I may have to try some antidepressants." b. "I need to limit my intake of caffeine." c. "I might try taking some vitamin E." d. "Salty foods will not affect this condition."

ANS: D Eating salty foods contributes to edema and fluid retention and should be avoided as much as possible. This statement indicates a lack of understanding. The other statements are all accurate.

14. With regard to the care management of preterm labor, nurses should be aware that a. teaching pregnant women the symptoms probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

ANS: D Gestational age of 20 to 37 weeks, uterine contractions, and a thinning cervix are all indications of preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in essential medications failing to be administered.

19. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods, such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

ANS: D Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes are not needed. Physical activity is beneficial for everyone but is not a treatment for this condition.

11. When caring for a postpartum woman experiencing hypovolemic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is a. absence of cyanosis in the buccal mucosa. b. cool, dry skin. c. diminished restlessness. d. decreased urinary output.

ANS: D Hemorrhage may result in hypovolemic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective in nature. The presence of cool, pale, clammy skin is an indicative finding associated with hypovolemic shock. Restlessness indicates decreased cerebral perfusion.

A woman with preeclampsia has a seizure. What action by the nurse takes priority? a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the patient and call for help.

ANS: D If a patient seizes, the nurse should stay with her and call for help. Nursing actions during a seizure are directed toward ensuring a patent airway and patient safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient's mouth. Oxygen may or may not be needed after the seizure has ended.

10. A laboring patient in the latent phase is experiencing uncoordinated, irregular contractions of low intensity. How should the nurse respond to complaints of constant cramping pain? a. "You are only 2 cm dilated, so you should rest and save your energy for when the contractions get stronger." b. "You must breathe more slowly and deeply so there is greater oxygen supply for your uterus. That will decrease the pain." c. "Let me take off the monitor belts and help you get into a more comfortable position." d. "I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps."

ANS: D Intervention is needed to manage the dysfunctional pattern. Offering support and comfort is important to help the patient cope with the situation. Telling the woman to rest is belittling her complaints. Breathing will not reduce the pain. Fetal monitoring should continue as the woman changes positions.

17. Which action should be initiated to limit hypovolemic shock when uterine inversion occurs? a. Administer oxygen at 31 L/min by nasal cannula. b. Administer an oxytocin by intravenous push. c. Monitor fetal heart rate every 5 minutes. d. Increase the intravenous infusion rate.

ANS: D Intravenous fluids are necessary to replace the lost blood volume that occurs in uterine inversion. The woman may need blood products as well. Administering oxygen will not prevent hypovolemic shock. Oxytocin should not be given until the uterus is repositioned. A uterine inversion occurs during the third stage of labor.

10. Informed consent concerning contraceptive use is important because some of the methods a. are invasive procedures that require hospitalization. b. require a surgical procedure to insert. c. may not be reliable. d. have potentially dangerous side effects.

ANS: D It is important for couples to be aware of potential side effects so they can make an informed decision about the use of contraceptives. The only contraceptive method that requires hospitalization is sterilization. The only surgical procedure used would be for permanent sterilization. Some have more effective rates, and this should be included in the teaching.

1. Which piece of the usual equipment setup for a pelvic examination is omitted with a Pap test? a. Gloves and eye protectors b. Speculum c. Fixative agent d. Lubricant

ANS: D Lubricants interfere with the accuracy of the cytology report. Gloves and eye protectors, speculum, and a fixative agent are all used during the exam.

13. What form of heart disease in women of childbearing years usually has a benign effect on pregnancy? a. Cardiomyopathy b. Rheumatic heart disease c. Congenital heart disease d. Mitral valve prolapse

ANS: D Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

20. Nafarelin (Synarel) is currently used as a treatment for mild to severe endometriosis. The nurse should tell the woman taking this medication that the drug a. stimulates the secretion of gonadotropin-releasing hormone (GnRH). b. may produce masculinizing effects. c. must be continued for at least a year. d. can cause her to experience some hot flashes and vaginal dryness.

ANS: D Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Danazole, another mediction to treat endometriosis causes masculinizing effects. Nararelin is used for 3 to 6 months usually.

16. A woman who had two previous cesarean births is in active labor, when she suddenly complains of pain between her scapulae. The nurse's priority action is to a. reposition the woman with her hips slightly elevated. b. observe for abnormally high uterine resting tone. c. decrease the rate of nonadditive intravenous fluid. d. notify the provider promptly and prepare the woman for surgery.

ANS: D Pain between the scapulae may occur when the uterus ruptures, because blood accumulates under the diaphragm. This is an emergency that requires surgical intervention so the nurse notifies the provider and prepares the woman for surgery. Repositioning the woman with her hips slightly elevated is the treatment for a prolapsed cord. That position in this scenario would cause respiratory difficulties. Since the uterus is no longer able to contract, high resting tones cannot be assessed. However, high resting tones during labor indicate a risk for uterine rupture. The woman is now at high risk for shock. Nonadditive intravenous fluids should be increased.

8. Glucose metabolism is profoundly affected during pregnancy because a. pancreatic function in the islets of Langerhans is affected by pregnancy. b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. c. the pregnant woman increases her dietary intake significantly. d. placental hormones are antagonistic to insulin, resulting in insulin resistance.

ANS: D Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day.

23. Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? a. Postpartum depression b. Postpartum psychosis c. Postpartum bipolar disorder d. Postpartum blues

ANS: D Postpartum blues, or "baby blues," is a transient self-limiting disease that is believed to be related to hormonal fluctuations after childbirth. Postpartum depression is not the normal worries (blues) that many new mothers experience. Many caregivers believe that postpartum depression is underdiagnosed and underreported. Postpartum psychosis is a rare condition that usually surfaces within 3 weeks of delivery. Hospitalization of the woman is usually necessary for treatment of this disorder. Bipolar disorder is one of the two categories of postpartum psychosis, characterized by both manic and depressive episodes.

16. One of the first symptoms of puerperal infection to assess for in the postpartum woman is a. fatigue continuing for longer than 1 week. b. pain with voiding. c. profuse vaginal bleeding with ambulation. d. temperature of 38° C (100.4° F) or higher after 24 hours.

ANS: D Postpartum or puerperal infection is any clinical infection after childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth. Fatigue is a later finding associated with infection. Pain with voiding may indicate a UTI, but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a. bed rest and analgesics are the recommended treatment. b. she will be unable to conceive in the future. c. a D&C will be performed to remove the products of conception. d. hemorrhage is the major concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before hemorrhaging. If the tube must be removed, her fertility will decrease but she will not be infertile. A D&C is done on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes.

26. While evaluating a patient for osteoporosis, the nurse should be aware of what risk factor? a. African-American race b. Low protein intake c. Obesity d. Cigarette smoking

ANS: D Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.

Which clinical sign is not included in the symptoms of preeclampsia? a. Hypertension b. Edema c. Proteinuria d. Glycosuria

ANS: D Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. Hypertension is usually the first sign noted. Edema occurs but is considered a non-specific sign. Edema can lead to rapid weight gain. Proteinuria should be assessed through a 24- hour UA.

8. Adjuvant treatment with tamoxifen may be recommended for patients with breast cancer if the tumor is a. smaller than 5 cm. b. located in the upper outer quadrant only. c. contained only in the breast. d. estrogen receptive.

ANS: D Tamoxifen is antiestrogen therapy for tumors stimulated by estrogen. Tamoxifen is used depending on age, stage, and hormone receptor status, not size. Location of the cancer does not determine the usefulness of tamoxifen. Stage of the cancer is a consideration, but more important is its sensitivity to estrogen.

13. A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurse's most appropriate response is a. "No spermicide is used with the cervical cap, so it's less messy." b. "The diaphragm can be left in place longer after intercourse." c. "Repeated intercourse with the diaphragm is more convenient." d. "You can have intercourse several times without removing the cap to add more spermicide."

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is needed inside the cap for repeated acts of intercourse but more is inserted into the vagina. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse but can stay in place up to 48 hours. Repeated intercourse with the cervical cap is more convenient, because no additional spermicide is needed.

21. The nurse who is teaching a group of women about breast cancer should tell the women that a. risk factors identify almost all women who will develop breast cancer. b. African-American women have a higher rate of breast cancer. c. 1 in 10 women in the United States will develop breast cancer in her lifetime. d. the exact cause of breast cancer is unknown.

ANS: D The exact cause of breast cancer in unknown. Risk factors help identify women who may get breast cancer and for whom increased surveillance is recommended; however, breast cancer can occur without risk factors. Caucasian women have a higher incidence of breast cancer; however, African-American women have a higher rate of dying of breast cancer after they are diagnosed. One in eight women in the United States will develop breast cancer in her lifetime.

28. What teaching does the nurse provide to help new mothers prevent postpartum depression? a. Stay home and avoid outside activities to ensure adequate rest. b. Be the only caregiver for your baby to facilitate infant attachment. c. Keep feelings of sadness and adjustment to your new role to yourself. d. Realize that this is a common occurrence that affects many women.

ANS: D The new mother should understand that postpartum depression is common. Rest is important, but she does not need to confine herself to the house. Others need to help care for the baby so the mother can rest. Women need to be open and discuss their feelings.

15. Which nursing action must be initiated first when evidence of prolapsed cord is found? a. Notify the provider. b. Apply a scalp electrode. c. Prepare the mother for an emergency cesarean delivery. d. Reposition the mother with her hips higher than her head.

ANS: D The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. The provider needs to be notified but not until the nurse has taken some corrective action. Trying to relieve pressure on the cord should take priority over increasing fetal monitoring techniques. Emergency cesarean delivery may be necessary if relief of the cord is not accomplished, but attempting to relieve the pressure takes priority. Trying to relieve pressure on the cord should be the first priority.

3. The nurse providing care in a women's health care setting must be aware that which sexually transmitted disease (STD) can be cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia

ANS: D The usual treatment for chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. Because no cure is known for herpes, treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the main focus. Condylomata acuminata (venereal warts) is caused by the human papillomavirus. No treatment eradicates the virus.

15. A woman with a history of a cystocele should contact the physician right away if she experiences a. involuntary loss of urine when she coughs. b. constipation. c. backache. d. urinary frequency and burning.

ANS: D Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Involuntary loss of urine during coughing is stress incontinence and is not an emergency. Constipation may be a problem with rectoceles. Back pain is a symptom of uterine prolapse.

What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa? a. Monitoring FHR and maternal vital signs b. Observing vaginal bleeding or leakage of amniotic fluid c. Determining frequency, duration, and intensity of contractions d. Determining cervical dilation and effacement

ANS: D Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage and is therefore contraindicated. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. Monitoring for bleeding and rupture of membranes is not contraindicated in this woman. Monitoring contractions is not contraindicated in this woman.

1. Which statement by a postpartum woman indicates that teaching about thrombus formation has been effective? a. "I'll stay in bed for the first 3 days after my baby is born." b. "I'll keep my legs elevated with pillows." c. "I'll sit in my rocking chair most of the time." d. "I'll put my support stockings on every morning before rising."

ANS: D Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning. As soon as possible, the woman should ambulate frequently. The mother should avoid knee pillows because they increase pressure on the popliteal space. Sitting in a chair with legs in a dependent position causes pooling of blood in the lower extremities.

1. Although circumcision continues to be a controversial procedure, many parents in the United States elect to have this surgery performed on their newborn sons. It is believed that newborns do not feel pain; therefore this is the optimum time for the procedure to be done and no anesthesia is required. Is this statement true or false?

ANS: F At one time it was thought that newborns felt no pain. It is now known that pain stimuli pass along the fetal pain pathways as early as the second and third trimester. The nurse who assists with this procedure has a number of options available to reduce the pain response for the neonate. These include a dorsal penile block, EMLA, acetaminophen, and sucrose.

2. Clotting factors and fibrinogen levels normally are decreased during pregnancy and remain low in the immediate puerperium. This hypocoagulable state increases the risk of thromboembolism, especially after cesarean birth. Is this statement true or false?

ANS: F Clotting factors and fibrinogen normally are increased during pregnancy and remain elevated in the immediate puerperium. This hypercoagulable state increases the risk of thromboembolism, especially after cesarean birth.

2. The cultural group in the United States that is most likely to breastfeed are non-Hispanic black women. Is this statement true or false?

ANS: F The cultural group with the lowest breastfeeding rates in the U.S. includes women who are non-Hispanic black. Women who are most likely to breastfeed are Asian, Pacific Islanders, or Hispanic. It is essential that the nurse educates this patient population on the benefits of breastfeeding and provides additional support.

1. Part of the newborn assessment includes examination of the umbilical cord. The cord should contain 2 vessels: one vein and one artery. Is this statement true or false?

ANS: F The umbilical cord contains 3 vessels: two small arteries and one large vein. A 2-vessel cord may be an isolated abnormality or it may be associated with chromosomal and renal defects.

2. In many facilities protocols allow the nurses to obtain transcutaneous bilirubin measurements (TcB) using a bilirubin meter, without the order of a nurse practitioner or physician. Is this statement true or false?

ANS: T Bilirubinometers are non-invasive devices to measure bilirubin levels in the infant's skin, thus avoiding repeated skin punctures to obtain blood samples. Abnormal results of TcB be should be confirmed with a total serum bilirubin (TsB). The National Association of Neonatal Nurses recommends obtaining a TcB or TsB on all infants prior to discharge.

2. An important nursing intervention is maintaining safe glucose levels in the newborn. A common practice is to feed infants either breast milk or formula if glucose screening shows results of 40 to 45 mg/dL or less. Is this statement true or false?

ANS: T Glucose water alone is not recommended for newborns because the rapid rise in glucose, will result in increased in sling production, causing a further drop in the blood glucose level. Milk provides a longer-lasting supply of glucose for the newborn.

1. The nurse evaluating the amount of lochia on a newly delivered patient knows that a moderate amount of flow constitutes a 4- to 6-inch stain on the peripad. Is this statement true or false?

ANS: T Since estimating the amount of lochia is difficult, nurses frequently record flow by estimating the amount of lochia in 1 hour using the following labels: Scant—less than a 1-inch stain on the peripad Light—a 1- to 4-inch stain Moderate—a 4- to 6-inch stain Heavy—saturated peripad Excessive—saturated peripad in 15 minutes Determining the time interval that the peripad is in place is also important. Lochia is less for women who have had a cesarean birth since some of the endometrial lining is removed during surgery.

1. At some hospitals in the United States, new mothers are given formula gift packs at discharge. Having been given the gift pack by hospital staff leads parents to believe that formula will be necessary even for breastfeeding mothers. Is this statement true or false?

ANS: T This is the goal of the formula manufacturers, and for this reason many hospitals have stopped providing new mothers with formula gift packs. For many parents, having formula available at home may lead them to feel that having to supplement breastfeeding is necessary. Adding formula to the infant's diet will lessen breastfeeding success because the introduction of supplemental feedings will reduce the amount of breastfeeding time, which in turn will decrease milk production.

25. A woman in the perinatal clinic asks the nurse how her asthma will affect her pregnancy and fetus. What response by the nurse is best? a. Asthma medications cannot be used during pregnancy. b. The only problem is that you will not be able to breastfeed. c. Medications for asthma do not appear to harm the fetus. d. Pregnancy tends to make asthma worse.

ANS: C Medications for asthma seem to be well tolerated during pregnancy. Breastfeeding is safe for the newborn. The course of asthma is variable in pregnancy.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 3.5 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, a missed abortion, or abruptio placentae.

2. While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning a. is the same as coitus interruptus, or "pulling out." b. uses the calendar method to align the woman's cycle with sexual activity. c. is used by 2% of Roman Catholics. d. relies on barrier methods during fertility phases.

ANS: C Natural family planning is used by about 2% of Roman Catholics. It is not the same a coitus interruptus. It uses a variety of methods to determine a woman's fertility. Those practicing natural family planning do not use barrier methods at any time.

29. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a patient with this condition should be aware that the optimal pharmacologic therapy for pain relief is a. acetaminophen. b. oral contraceptives (OCPs). c. nonsteroidal anti-inflammatory drugs (NSAIDs). d. aspirin.

ANS: C Nonsteroidal anti-inflammatory medications are the first-line drug for primary dysmenorrhea. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have a number of potential side effects. Aspirin is usually not as effective as NSAIDs but can be used.

3. A nurse is providing information about contraceptives to a couple. Which contraceptive method provides protection against sexually transmitted diseases? a. Oral contraceptives b. Tubal ligation c. Male or female condoms d. Intrauterine device (IUD)

ANS: C Only the barrier methods provide some protection from sexually transmitted diseases. Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease. Oral contraceptives, tubal ligations, or IUDs do not provide protection against STDs.

5. Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? a. A primigravida who is 17 years old b. A 22-year-old multiparous woman with ruptured membranes c. A multiparous woman at 39 weeks of gestation who is expecting twins d. A primigravida woman who has requested no analgesia during her labor

ANS: C Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this woman's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

27. To provide adequate postpartum care, the nurse should be aware that peripartum depression (PPD) a. is the "baby blues," plus the woman has a visit with a counselor or psychologist. b. does not affect the father who can then care for the baby. c. is distinguished by pervasive sadness that lasts at least 2 weeks. d. will disappear on its own without outside help.

ANS: C PPD is characterized by a persistent depressed state. The woman is unable to feel pleasure or love although she is able to care for her infant. She often experiences generalized fatigue, irritability, little interest in food and sleep disorders. PPD is more serious and persistent than postpartum baby blues. Fathers are often affected. Most women need professional help to get through PPD, including pharmacologic intervention.

The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. vaginal bleeding. b. rupture of membranes. c. presence of abdominal pain. d. changes in maternal vital signs.

ANS: C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding, but both may have vaginal bleeding. Rupture of membranes may occur with both conditions. Maternal vital signs may change with both if bleeding is pronounced.

18. The drug of choice to treat gonorrhea is a. penicillin G. b. tetracycline. c. ceftriaxone. d. acyclovir.

ANS: C Penicillin is the drug of choice used to treat syphilis.

5. A nurse in labor and delivery learns about metabolic changes that occur throughout pregnancy in diabetes. What information does the nurse know? a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester, because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy.

ANS: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own around the tenth week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia. Maternal insulin requirements may double or quadruple by the end of pregnancy.

7. Which factor is known to increase the risk of gestational diabetes mellitus? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus

ANS: C Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already is a diabetic and will continue to be so during and after pregnancy.

12. In planning for home care of a woman with preterm labor, the nurse needs to address which concern? a. Nursing assessments will be different from those done in the hospital setting. b. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers will be necessary.

ANS: C Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor but not in all women. Many, but not all, women will receive home health nurse visits.

The prenatal clinic nurse monitored women for preeclampsia. If all four women were in the clinic at the same time, which one should the nurse see first? a. Blood pressure increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ is indicative of severe preeclampsia and should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or higher. Preeclampsia may be manifested as a rapid weight gain. Gaining 0.5 kg during the past 2 weeks does not qualify as rapid. Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

14. Which woman is most likely to have osteoporosis? a. A 50-year-old woman receiving estrogen therapy b. A 60-year-old woman who takes supplemental calcium c. A 55-year-old woman with a sedentary lifestyle d. A 65-year-old woman who walks 2 miles each day

ANS: C Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet. Hormone therapy may prevent bone loss. Supplemental calcium will help prevent bone loss, especially when combined with vitamin D. Weight-bearing exercises have been shown to increase bone density.

9. Which statement is true about primary dysmenorrhea? a. It occurs in young multiparous women. b. It is experienced by all women. c. It may be due to excessive endometrial prostaglandin. d. It is unaffected by oral contraceptives.

ANS: C Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. It usually occurs in young nulliparous women. It is not experienced by all women. Oral contraceptives can be a treatment choice.

11. With regard to endometriosis, nurses should be aware that a. it is characterized by the presence and growth of endometrial tissue inside the uterus. b. it affects 25% of all women. c. it may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. it is unlikely to affect sexual intercourse or fertility.

ANS: C Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis affects 10% of all women and is found equally in Caucasian and African-American women. With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating. Women can experience painful intercourse and impaired fertility.